心脏死亡供体使用血管活性药物对肾移植受者术后早期肾功能及相关并发症的影响。

Impact of the use of vasoactive drugs in cardiac death donors on the early postoperative renal function and related complications in renal transplant recipients.

作者信息

Zhang Peng, Cao Peihua, Fang Jiali, Li Guanghui, Zhang Lei, Xu Lu, Mo Shijing, Lai Xingqiang, Liu Luhao, Xiong Yunyi, Yin Wei, Li Li, Chen Rongxin, Xu Hailin, Zhang Tao, Wan Jiao, Guo Yuhe, Ma Junjie, Chen Zheng

机构信息

Organ Transplant Center, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou511447, China.

Clinical Research Center, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China.

出版信息

Ann Transl Med. 2020 Feb;8(4):116. doi: 10.21037/atm.2019.12.99.

DOI:10.21037/atm.2019.12.99

PMID:32175409

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7048973/

Abstract

BACKGROUND

To explore the impact of the use of vasoactive drugs in donation after cardiac death (DCD) donors on graft function, with an attempt to guide the clinical practices of organ preservation and DCD kidney transplantation.

METHODS

The clinical data of 187 DCD donors and 304 recipients who were operated on in our center from February 2018 to May 2019 were retrospectively analyzed. Based on whether vasoactive drugs were used for maintaining blood pressure in DCD donors, the renal donors and recipients were divided into a high-dose group (norepinephrine ≥1.3 µg/kg/min or in combination with dopamine), a low-dose group (norepinephrine <1.3 µg/kg/min or in conjunction with dopamine), and a no-medication group (without the use of vasoactive drugs). The clinical features, post-transplant renal function, and complications were compared among these three groups.

RESULTS

The early renal function 1 and 7 days after surgery was significantly superior in the high-dose group and no-medication group (P<0.05) but showed no significant difference between the low-dose group and the no-medication group (P>0.05). Blood urea nitrogen (BUN) on the 1st postoperative days was significantly higher in the high-dose group than in the low-dose group and the no-medication group (P<0.05). Renal function indicators, including serum creatinine (CRE), BUN, and blood uric acid (UA) on the 30th postoperative day, showed no significant difference among these three groups (P>0.05). The incidence of delayed graft function (DGF) after renal transplantation was significantly higher in the high-dose group than in the low-dose group and the no-medication group (P<0.05), whereas there was no significant difference between the groups in the incidences of graft rejection and infections (P>0.05).

CONCLUSIONS

The use of vasoactive drugs in DCD donors can affect the early recovery of renal function in renal transplant recipients, particularly for those donors who are administered a high dose of vasoactive drugs. Therefore, donor maintenance should be performed cautiously with vasoactive drugs.

摘要

背景

探讨心脏死亡后器官捐献（DCD）供体使用血管活性药物对移植肾功能的影响，以期指导器官保存及DCD肾移植的临床实践。

方法

回顾性分析2018年2月至2019年5月在本中心接受手术的187例DCD供体及304例受体的临床资料。根据DCD供体是否使用血管活性药物维持血压，将肾供体及受体分为高剂量组（去甲肾上腺素≥1.3μg/kg/min或联合多巴胺）、低剂量组（去甲肾上腺素<1.3μg/kg/min或联合多巴胺）及未用药组（未使用血管活性药物）。比较三组的临床特征、移植后肾功能及并发症情况。

结果

高剂量组和未用药组术后1天及7天的早期肾功能明显优于低剂量组（P<0.05），但低剂量组与未用药组之间差异无统计学意义（P>0.05）。术后第1天高剂量组的血尿素氮（BUN）明显高于低剂量组和未用药组（P<0.05）。术后第30天的肾功能指标，包括血清肌酐（CRE）、BUN及血尿酸（UA）在三组间差异无统计学意义（P>0.05）。肾移植后移植肾功能延迟恢复（DGF）的发生率高剂量组明显高于低剂量组和未用药组（P<0.05），而各组间移植排斥反应及感染发生率差异无统计学意义（P>0.05）。