【摘要】 目的:探讨心脏死亡供体(death cardiac donor,DCD)的移植肾肾功能延迟恢复(delayed graft function,DGF)发生的危险因素及预后情况。方法:收集中南大学湘雅三医院器官移植中心及武汉中南医院2010年2月至2012年3月的48例DCD肾移植受者,分为DGF组(n=18)及肾功能稳定(immediate graft function,IGF)组(n=30)。分析发生DGF的危险因素。结果:DGF的发生率为37.5%,在单因素分析中受者术前透析时间(P<0.001)、HLA错配位点(P<0.001)、脑出血死亡供体(P=0.011)、供者BMI(P<0.001)、术前SCr(P<0.001)、使用去甲肾上腺素(P<0.001)、热缺血时间(P<0.001)、冷缺血时间(P<0.001)为DGF的危险因素,在多因素分析中,受体术前透析时间≥12个月(P=0.060,OR=15.060)、脑出血死亡供体(P=0.022,OR=39.652)、供体术前SCr≥177μmol/L(P=0.008,OR=57.148)为DGF独立的危险因素。结论:DGF的独立危险因子是受体术前透析时间≥12个月、供体术前SCr≥177μmol/L、脑出血死亡供体。更多还原

【Abstract】 Objective: To evaulate the risk factors of delayed graft function(DGF) and its impact on renal transplantation from donation after cardiac death(DCD). Methods: We conducted a retrospective study consisting of 48 subjects who underwent a DCD kidney transplantation from February 2010 to March 2012.We classified the recipients into two groups: an IGF(immediate graft function) group(n=30) and a DGF group(n=18),and analyzed the risk factors of DGF and its impact on transplantation. Results: DGF occurred in 18 of the 48(37.5%) kidenys from DCD donors,and the occurrence of DGF did not adversely influence the survival of patients(P=0.098) and graft(P=0.447).In the univariate analysis,the preoperative dialysis time of recipients(P<0.001),HLA mismatch site(P<0.001),the cause of brain death(P=0.011),BMI(P<0.001),preoperative serum creatinine of donors(P=0.0001),norepinephrine used in donors(P<0.001),warm ischema time(WIT)(P<0.001),cold ischema time(CIT)(P<0.001) showed significant differences.In the multivariate analysis,cerebral hemorrhage as the cause of brain death(P=0.022,OR=39.652),preoperative serum creatinine of donors≥177 μmol/L(P=0.008,OR=57.148) and the preoperative dialysis time of recipients≥12 months(P=0.060,OR=15.060) were independent risk factors for DGF development. Conclusion: The independent risk factors for DGF are the cause of brain death,the terminal creatinine level,and the preoperative dialysis time.更多还原