摘要目的 探讨死亡后器官捐献(DD)横纹肌溶解症供者的维护与评估及其供肾移植的经验.方法 回顾性分析2例横纹肌溶解症伴AKI供者的维护与评估及其供肾移植3例的临床资料.结果 2例供者入院时血肌酐分别为64和74 μmol/L,均无尿,血浆肌酸激酶值分别为8 600和10 600U/L;获取供肾前彩色超声检查显示供肾血流信号丰富,血肌酐分别为308和＞700 μmol/L;移植前快速冰冻病理检查显示,供者1可见双肾部分急性肾小管坏死,供者2部分肾小管管腔内可见管型,均未见未见肾小球硬化、间质纤维化及微血栓形成.获取供肾时肾脏呈棕褐色,移植肾恢复血流后呈深褐色.2例供者维护期治疗包括纠正电解质紊乱、碱化尿液、扩容及营养支持治疗.对于横纹肌溶解症供者维护的主要措施主要为碱化尿液及纠正电解质紊乱;对供肾的评估则是根据病理活检.3例受者术后均发生肾功能恢复延迟,受者1和2术后3周左右开始泌尿,血肌酐进行性下降,恢复正常后出院;受者3术后2周左右因移植肾区隆起行移植肾探查,术中见移植肾呈鲜红色,行血肿清除及止血后尿量逐渐增多,血肌酐进行性下降,术后2个月血肌酐为103μmol/L.结论 对于横纹肌溶解症供者,给予积极维护,并充分评估供肾功能、血流情况等综合因素后,此类供肾可应用于移植,并可取得良好的近期效果.

abstractsObjective To summarzie the experiences of kidney transplantation from rhabdomyolysis.Methods The surgical procedures and treatment protocols of the kidney transplantation in 3 cases from DD donors who suffered from anuria due to rhabdomyolysis were retrospectively analyzed.Results Three recipients were donated by two donors.When the blood of kidneys is washed out,the color of the kidneys was brown,and when the kidneys restored the blood perfusion,the transplanted kidneys were dark brown.All of these 3 cases had delayed renal function,and 2 recipients who received the kidneys from the same donor secreted the urine 3 weeks after surgery.The creatinine gradually decreased,and they discharged when the renal function was normal.The urine volume in the another recipient was 3000 ml or more per day in the first two days,gradually decreased from the third day,until anuria.We conducted an exploration of the transplanted kidney due to the area of transplantation uplift.We found that the kidney was bright red during the operation,the hematoma was removed and hemostasis was done,the urine volume gradually increased from one week after surgery,and the creatinine levels gradually decreased.After two months the creatinine levels were 103μmol/L.Conclusion For the patients with rhabdomyolysis,their kidneys can be transplanted after active preservation,evaluation of the donor kidney function and blood flow,and the short-term outcome is satisfactory.