活体供肾移植：我们应走多远？

Baskent University and Transplantation and Burn Centers.

Urol J. 2004 Summer;1(3):148-56.

INTRODUCTION

The aim of this review was to describe the work that the Başkent University Faculty of Medicine has done to increase kidney donors' number in Turkey and also to discuss the major effects that donor-organ shortage is currently having worldwide.

MATERIALS AND METHODS

From 1975 through 2003, our transplantation team at Hacettepe University Hospital and later at the Başkent University Transplantation Center (BUTC) performed 1451 kidney transplantations. Cadaver donation rates prior to and after the establishment of the National Coordination Center (NCC) were calculated and compared. Also, patient and graft survival rates for various groupings of transplantation types were compared. All statistical analysis was done using the log-rank test.

RESULTS

Of all the renal transplantations completed in Turkey from 1975 to January 2004, 20% were performed by our team in our center. For the years 1990 through 2003, the 1-, 3-, and 5-year patient survival rates in the first-degree-living-related kidney transplantation group were 96%, 93%, and 91%, respectively, and the corresponding graft survival rates were 93%, 84%, and 81%. In the second-degree living-related group, the 1-, 3-, and 5-year patient survival rates were 94%, 90%, and 87%, respectively, and the corresponding graft survival rates were 93%, 86%, and 84%. For living-unrelated transplantations, the 1-, 3- and 5-year patient survival rates were 93%, 90%, and 83%, respectively, and the corresponding graft survival rates were 83%, 78%, and 76%. In the cadaver-kidney transplantation group, the 1-, 3- and 5-year patient survival rates were 85%, 78%, and 70%, respectively, and the corresponding graft survival rates were 82%, 64%, and 53%. During this same period, the 1-, 3-, and 5-year graft survival rates for our cadaver donors and living donors older than 55 years of age were 80%, 52%, 46% and 88%, 69%, 61%, respectively.

CONCLUSION

Vigorous efforts by our group at Başkent University and by other transplant surgeons across the nation have increased the numbers of transplantations performed each year. As well, since the NCC was established in 2001, the number of cadaver-kidney transplantations has more than doubled. The initial results with this new nationwide organ-sharing system are promising, and there is every indication that this approach will continue to raise the number of transplant operations performed across Turkey each year. We suggest that Turkish citizens should consider changing our national policies on organ donation. Opt-out policies can increase the pool of cadaver-organ transplants. In addition, to increasing cadaver donation, we feel that living-related donation restricted to first- and second-degree relatives and acceptable non-blood-related donors (such as spouses) is the best path to expanding kidney transplantation worldwide.

引言

本综述的目的是描述巴斯肯特大学医学院为增加土耳其肾脏捐赠者数量所做的工作，并讨论目前全球范围内供体器官短缺所产生的主要影响。

材料与方法

从1975年到2003年，我们在哈杰泰佩大学医院以及后来在巴斯肯特大学移植中心（BUTC）的移植团队共进行了1451例肾脏移植手术。计算并比较了国家协调中心（NCC）成立前后的尸体捐赠率。此外，还比较了不同移植类型分组的患者和移植物存活率。所有统计分析均采用对数秩检验。

结果

在1975年至2004年1月土耳其完成的所有肾脏移植手术中，我们中心的团队完成了20%。在1990年至2003年期间，一级亲属活体肾移植组的1年、3年和5年患者存活率分别为96%、93%和91%，相应的移植物存活率分别为93%、84%和81%。在二级亲属活体肾移植组中，1年、3年和5年患者存活率分别为94%、90%和87%，相应的移植物存活率分别为93%、86%和84%。对于非亲属活体移植，1年、3年和5年患者存活率分别为93%、90%和83%，相应移植物存活率分别为83%、78%和76%。在尸体肾移植组中，1年、3年和5年患者存活率分别为85%、78%和70%，相应的移植物存活率分别为82%、64%和53%。在同一时期，我们的尸体供体和年龄超过55岁的活体供体的1年、3年和5年移植物存活率分别为80%、52%、46%和88%、69%、61%。

结论

我们巴斯肯特大学的团队以及全国其他移植外科医生的积极努力增加了每年进行的移植手术数量。此外，自2001年国家协调中心成立以来，尸体肾移植数量增加了一倍多。这个新的全国性器官共享系统的初步结果很有希望，而且有充分迹象表明这种方法将继续提高土耳其每年进行的移植手术数量。我们建议土耳其公民应考虑改变我国关于器官捐赠的政策。选择退出政策可以增加尸体器官移植的来源。此外，为了增加尸体捐赠，我们认为将活体亲属捐赠限制在一级和二级亲属以及可接受的非血缘关系捐赠者（如配偶）是全球扩大肾脏移植的最佳途径。