肾移植的活体亲属供体和非亲属供体。28年的经验。

Living related and unrelated donors for kidney transplantation. A 28-year experience.

作者信息

D'Alessandro A M, Sollinger H W, Knechtle S J, Kalayoglu M, Kisken W A, Uehling D T, Moon T D, Messing E M, Bruskewitz R C, Pirsch J D

机构信息

Department of Surgery, University of Wisconsin Medical School, Madison, USA.

出版信息

Ann Surg. 1995 Sep;222(3):353-62; discussion 362-4. doi: 10.1097/00000658-199509000-00012.

DOI:10.1097/00000658-199509000-00012

PMID:7677464

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1234817/

Abstract

OBJECTIVE

The objective of this study was to analyze a single center's 28-year experience with 1000 living donor transplants.

SUMMARY BACKGROUND DATA

The number of potential renal transplant recipients far exceeds the number of cadaveric donors. For this reason, living related donors (LRDs) and, more recently, living unrelated donors (LURDs) have been used to decrease the cadaveric donor shortage.

METHODS

From November 15, 1966, until August 5, 1994, 1000 living donor transplants were performed; 906 were living related and 94 were living unrelated transplants. Results were divided into precyclosporine (1966-1986, era I) and cyclosporine (1986-1994, era II) eras. Patient and graft survivals were compared between diabetic and nondiabetic recipients, between LRDs and LURDs, and according to human leukocyte antigen (HLA) matching. Donor mortality, morbidity, and postoperative renal function were also analyzed.

RESULTS

The 5-, 10-, and 20-year graft survivals were 78.8%, 64.8%, and 43.4%, respectively. Patient and graft survival improved in era II (patient = 87.0% vs. 81.7%, p = 0.03; graft = 72.9% vs. 67.7%, p = 0.04). Nondiabetic patient and graft survivals were better than diabetic patient survivals in both eras. However, diabetic patient survival improved in era II (78.0% vs. 66.9%, p = 0.04). In era II, HLA-identical recipients had better graft survival than haploidentical or mismatched recipients (91.7% vs. 67.3% and 66.1%, p = 0.01). No difference between haploidentical LRDs and LURDs was seen. One donor death occurred in 1970, and 17% of donors developed postoperative complications.

CONCLUSION

Living related and unrelated renal donation continues to be an important source of kidneys for patients with end-stage renal disease.

摘要

目的

本研究的目的是分析一个单一中心在1000例活体供肾移植方面的28年经验。

总结背景数据

潜在肾移植受者的数量远远超过尸体供者的数量。因此，亲属活体供者（LRD）以及最近的非亲属活体供者（LURD）已被用于缓解尸体供者短缺的问题。

方法

从1966年11月15日至1994年8月5日，共进行了1000例活体供肾移植；其中906例为亲属活体移植，94例为非亲属活体移植。结果分为环孢素应用前（1966 - 1986年，时期I）和环孢素应用后（1986 - 1994年，时期II）两个时期。对糖尿病和非糖尿病受者之间、LRD和LURD之间以及根据人类白细胞抗原（HLA）配型情况的患者和移植物存活率进行了比较。还分析了供者死亡率、发病率和术后肾功能。

结果

5年、10年和20年的移植物存活率分别为78.8%、64.8%和43.4%。在时期II患者和移植物存活率有所提高（患者 = 87.0%对81.7%，p = 0.03；移植物 = 72.9%对67.7%，p = 0.04）。在两个时期，非糖尿病患者和移植物存活率均优于糖尿病患者存活率。然而，糖尿病患者存活率在时期II有所提高（78.0%对66.9%，p = 0.04）。在时期II，HLA配型相同的受者移植物存活率优于单倍型相同或配型不合的受者（91.7%对67.3%和66.1%，p = 0.01）。单倍型相同的LRD和LURD之间未观察到差异。1970年发生1例供者死亡，17%的供者出现术后并发症。