Tóth M, Réti V, Gondos T
Department of Transplantation and Surgery, Semmelweis Medical University, Budapest, Hungary.
Clin Transplant. 1998 Dec;12(6):511-7.
In this prospectively collected data base multifactorial study, the influence of the peri-operative recipients' parameters on the transplanted kidney function were examined. One hundred and twenty-one patients who underwent first cadaver kidney transplantation in our unit were involved and were followed up for another 2 yr. The recipients were divided into three groups. Group I, patients with non-functioning grafts, group II, with delayed graft function, and group III, with good graft function. All routinely measured parameters were involved in the examination. The pre-operative haematocrit level differed significantly among the three groups. Significant intra-operative differences were found among the three groups in mean arterial pressure, (group I: 81 +/- 31 mmHg, group II: 90 +/- 24 mmHg, vs. group III: 108 +/- 26 mmHg, p < 0.01) at 5 min before revascularisation. The patients who had better post-operative kidney function, had lower pre-operative haematocrit level, and higher blood pressure in the different phase of operation, than those who had post-operative kidney function problems. The second warm ischaemic time in Group III was significantly shorter than in group I. (Group I: 51.5 min vs. group II: 47 min, vs. group III: 46.3 min, p < 0.001). Rejection rate was higher during the first 5 post-operative days in patients with non-functioning grafts. (Group I: 53% and group II: 24% vs. group III: 12% p < 0.001). The other examined parameters had not differed significantly among the three groups. The kidney function differences observed in the early (first 5 d) post-operative period, remained similar at the end of the next 2 yr. According to our results the peri-operative fluid-balance is one of the most important factors which may influence the success of the kidney transplantation.
在这项前瞻性收集数据库的多因素研究中，考察了围手术期受者参数对移植肾功能的影响。纳入了在我院接受首次尸体肾移植的121例患者，并对其进行了另外2年的随访。将受者分为三组。第一组为移植肾无功能的患者，第二组为移植肾功能延迟的患者，第三组为移植肾功能良好的患者。所有常规测量的参数都纳入了检查。三组患者术前的血细胞比容水平有显著差异。三组患者在血管再通前5分钟时的平均动脉压存在显著的术中差异（第一组：81±31 mmHg，第二组：90±24 mmHg，第三组：108±26 mmHg，p<0.01）。术后肾功能较好的患者，与术后肾功能有问题的患者相比，术前血细胞比容水平较低，且在手术不同阶段血压较高。第三组的第二次热缺血时间明显短于第一组（第一组：51.5分钟，第二组：47分钟，第三组：46.3分钟，p<0.001）。移植肾无功能的患者术后前5天的排斥反应发生率较高（第一组：53%，第二组：24%，第三组：12%，p<0.001）。其他检查参数在三组之间没有显著差异。术后早期（前5天）观察到的肾功能差异，在接下来的2年结束时仍然相似。根据我们的结果，围手术期的液体平衡是可能影响肾移植成功的最重要因素之一。
