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目的探讨亲属活体肾移植的疗效。方法亲属活体肾移植162例,除7例为夫妻间供肾外,其余为血缘亲属供肾。人类白细胞抗原(human leukocyte antigen,HLA)抗原错配5个4例、抗原错配4个6例、抗原错配3个101例、抗原错配2个51例。全部供者经开放手术取肾。受者术后采用环孢素或他克莫司+麦考酚吗乙酯+泼尼松龙三联免疫抑制治疗方案预防排斥反应。结果供者中除2名出现一过性血清肌酐升高外,其余肾功能均在正常范围内。162例受者中,术后早期肾功能恢复正常157例,肾功能延迟恢复5例,急性排斥反应5例,输尿管血栓形成2例,慢性排斥反应3例。1、3、5年人存活率均为96.9%,1、3、5年肾存活率分别为96.3%、95.8%、95.0%。死亡5例,死亡时间为移植后3个月内,均死于重度肺部感染并呼吸衰竭。结论亲属活体肾移植的组织配型好,供者术前准备充分,供肾缺血时间短,受者术前有充足的免疫诱导时间,免疫抑制剂用量小,排斥反应发生率低,移植肾存活率高。
Objective To investigate the efficacy of living donor kidney transplantation. Methods Relatives living donor kidney transplantation in 162 cases, except for 7 cases for the husband and wife for the kidney, the remaining blood relatives for the kidney. There were 5 mismatches of human leukocyte antigen (HLA) in 5 cases, 6 cases of mismatched antigen in 4 cases, 101 cases of mismatched antigen in 3 cases and 51 cases of mismatched antigen in 2 cases. All donors were treated by open surgery. Recipients were treated with cyclosporine or tacrolimus + mycophenolate monecology plus prednisolone triple immunosuppressive regimen to prevent rejection. Results In addition to two patients with transient serum creatinine increased, the remaining renal function are in the normal range. Of the 162 recipients, 157 were normal early postoperative renal function, 5 were delayed renal function recovery, 5 were acute rejection, 2 were urethral thrombosis and 3 were chronic rejection. The survival rates at 1, 3, and 5 years were 96.9%, and those at 1, 3 and 5 years were 96.3%, 95.8% and 95.0%, respectively. 5 died and died within 3 months after transplantation, both died of severe pulmonary infection and respiratory failure. Conclusion The relatives of living donor kidney transplantation have good histopathology, adequate preoperative preparation, short donor kidney ischemia time, adequate immunization induction time, low dosage of immunosuppressant, low incidence of rejection, High survival rate.