Azar S A, Nakhjavani M R, Tarzamni M K, Faragi A, Bahloli A, Badroghli N
Transplantation Ward, Emam Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
Transplant Proc. 2007 May;39(4):822-3. doi: 10.1016/j.transproceed.2007.04.017.
Living donor kidney transplantation (LDKT) yields the best results of all renal replacement therapies in terms of patient and graft survival. It is the main method in many countries because of worsening patient outcomes due to the accumulation of aged patients with long periods on dialysis and no possibility to increase the number of cadaver donor transplantations. Because of concerns dealing the risks inflicted on the donors, we sought to evaluate the long-term complications of LDKT.
We evaluated over 3 years 86 living kidney donors (58 men, 28 women) whose procedures were >1 year ago. The mean time postoperatively was 17.24 +/- 5.04 months and their mean age, 28.97 +/- 4.75 years. Basic information regarding current health status, including physical examination and blood pressure as well as serum urea, creatinine serum albumin, blood glucose, lipid profile, urinanalysis, and 24-hour urine protein were evaluated every 6 months after donation. Also an ultrasound of the kidney, urinary tract, and testis was performed at these times.
Donor nephrectomies were left sided in 60 (69.8%) cases and right sided in 26 (30.2%) cases. The majority of the donors (n=80) were unrelated (93%). There was a total complication rate of 54.6%. The most common complication was hypertension (37.5%). Serious complications occurred in five cases (5.8%). In six (6.9%) the patients serum creatinine was >or=1.4 mg/dL. Microalbuminuria was found in 10.4%; hematuria in 13.9%; pyuria in 8.1%; and renal stone in 6.9%. Varicocele was found in 24.1% of male patients (23.3% of patients who had left nephrectomised). Persistent pain was reported by 44.1%. Antidepressants were prescribed to 9.3% of donors because of severe depression.
Living kidney donation is not so safe and has some late complications. Precise predonation evaluation and long-term follow-up of kidney donors for detection and prevention of complications is necessary.
就患者和移植物存活率而言，活体供肾移植（LDKT）在所有肾脏替代疗法中效果最佳。由于透析时间长的老年患者数量增加且尸体供肾移植数量无法增加导致患者预后恶化，它在许多国家成为主要治疗方法。鉴于对供体所受风险的担忧，我们试图评估活体供肾移植的长期并发症。
我们对86例活体肾供体（58例男性，28例女性）进行了超过3年的评估，这些供体的手术时间在1年以上。术后平均时间为17.24±5.04个月，平均年龄为28.97±4.75岁。捐赠后每6个月评估一次当前健康状况的基本信息，包括体格检查、血压以及血清尿素、肌酐、血清白蛋白、血糖、血脂谱、尿液分析和24小时尿蛋白。此时还对肾脏、尿路和睾丸进行超声检查。
60例（69.8%）供肾切除术为左侧，26例（30.2%）为右侧。大多数供体（n = 80）为非亲属（93%）。总并发症发生率为54.6%。最常见的并发症是高血压（37.5%）。5例（5.8%）发生严重并发症。6例（6.9%）患者血清肌酐≥1.4mg/dL。微量白蛋白尿的发生率为10.4%；血尿为13.9%；脓尿为8.1%；肾结石为6.9%。24.1%的男性患者（左侧肾切除患者的23.3%）发现精索静脉曲张。44.1%的患者报告有持续疼痛。9.3%的供体因严重抑郁而开具了抗抑郁药。
活体肾捐赠并非那么安全，存在一些晚期并发症。对肾脏供体进行精确的捐赠前评估和长期随访以检测和预防并发症是必要的。
