Hospital of Nephrology, The First Affiliated Hospital of Medical College, Xi'an Jiaotong University, 277 Yanta West Road, Xi'an 710061, Shaanxi, China.
Int Urol Nephrol. 2013 Feb;45(1):239-49. doi: 10.1007/s11255-012-0259-0. Epub 2012 Aug 15.
Renal transplantation is the best options for treating end-stage renal disease. Better patient and allograft survival rates are provided by living donation, which has been safe, with minimal immediate and long-term risk for the donor. This study aims to investigate the life status and summarize the clinical experience in living-related kidney transplant (LRKT) before and after renal transplantation.
A total of 310 cases of LRKT have been performed in our center since 1998. Tissue matching and risk factors assessment in donors and recipients were performed before donation. Small lumbar incision was used in all cases for unilateral nephrectomy. Donors and recipients were followed up regularly after renal transplantation.
All living donors were healthy, with normal renal function after unilateral nephrectomy. The 1- and 5-year patient/graft survival rates of LRKT were 98.3 %/97.6 % and 91.3 %/86.9 %, respectively. The cumulative incidence of delayed graft function (DGF) and acute rejection (AR) was 2.9 % (9 cases). Thirteen cases developed pulmonary infection (4.2 %) and eight cases were cured. The graft function in most cases returned to normal range soon after kidney transplant. Moreover, the creatinine and BUN levels of grafts donated by children or siblings of recipients were markedly lower than those donated by parents, at 1 month after transplant.
Adequate pretransplant assessment, better tissue matching, and reduced ischemia time may result in lower incidence of DGF, AR and higher patient/graft survival rates for LRKT. It is important to improve selection criteria and health assessment of donors. Long-term follow-up is essential to ensure a healthy life for donors and recipients after kidney transplant.
肾移植是治疗终末期肾病的最佳选择。活体供肾具有更好的患者和移植物存活率，且供者的风险极小，既安全又微创。本研究旨在探讨活体相关肾移植（LRKT）前后供者的生活状况，并总结其临床经验。
自 1998 年以来，我们中心共进行了 310 例 LRKT。在供者和受者捐献前，对其进行组织配型和风险因素评估。所有病例均采用小切口行单侧肾切除术。肾移植后，对供者和受者进行定期随访。
所有活体供者均健康，单侧肾切除术后肾功能正常。LRKT 的 1 年和 5 年患者/移植物存活率分别为 98.3%/97.6%和 91.3%/86.9%。延迟肾功能恢复（DGF）和急性排斥反应（AR）的累积发生率为 2.9%（9 例）。13 例发生肺部感染（4.2%），8 例治愈。大多数患者在肾移植后不久，移植物功能即恢复正常。此外，受体子女或兄弟姐妹供肾的移植术后 1 个月时，其肌酐和 BUN 水平明显低于父母供肾。
充分的移植前评估、更好的组织配型和减少缺血时间可能会降低 LRKT 的 DGF、AR 发生率，提高患者/移植物存活率。重要的是要提高供者的选择标准和健康评估。长期随访对于确保肾移植后供者和受者的健康生活至关重要。
