Comparative Analysis Of Clinical Effects Of Deceased Donor And Living Donor Kidney Transplantation

Objective:With the progress of modern medical civilization and the relatively peaceful environment of the world,the average life expectancy of human beings has been significantly extended,and the symptoms of abnormal deaths have gradually decreased.At the same time,the number of deaths from chronic diseases is increasing year by year.Among them,the prevalence of chronic kidney disease is increasing,and it has become one of the important diseases endangering public health.The final developmental outcome of chronic kidney disease is end stage renal disease（ESRD）.Current treatments for ESRD include dialysis（hemodialysis and peritoneal dialysis）and kidney transplantation.Compared with dialysis,kidney transplantation has the advantages of higher quality of life after surgery and longer life expectancy.There are two types of kidney transplantation:citizen deceased donor（DD）and living donor（LD）kidney transplantation.In clinical practice,the comparison of the efficacy of the two types of kidney transplantation has always been a key topic of discussion.The purpose of this study was to investigate the clinical effect of single-center DD and LD kidney transplantation.Methods:Selected the 254 cases of kidney transplantation who completed in our hospital from January 1,2017 to December 31,2018 and had complete follow-up data as the research objects,and divided them into LD group（113cases）and the DD group（141 cases）according to the type of kidney donor.Gender,age,height,preoperative body weight,serum creatinine values before surgery and on the 3rd and 7th day after surgery,1 month,2 months and 12 months after surgery,as well as postoperative hospital stay of the two groups were collected.The incidence of complications such as acute rejection,delayed graft function（DGF）and pulmonary infection and the survival of the recipient/graft were observed in both groups after renal transplantation.The measurement data of normal distribution were compared by independent sample T test.The measurement data of non-normal distribution were compared by Mann-Whitney U test.The statistical data were compared by chi-square test or Fisher’s exact probability method.The postoperative survival curves of DD group and LD group were drawn by kaplan-Meier method and compared by log-rank test.P<0.05 was considered statistically significant.Results:Age,preoperative dialysis time,postoperative hospital stay,and serum creatinine at 3,7,1 and 2 months in LD group were（32±8）years,（20±25）months,（24±8）months,and（195±121）,（135±73）,（113±53）and（115±49）μmol/L,respectively,the DD group was（42±10）years old,（47±39）months,（38±46）months and（483±326）,（333±267）,（208±160）and（172±138）μmol/L,the difference is statistically significant（t=8.552,Z=-7.002,-2.810,-7.844,-7.055,-6.129 and-2.139,all P<0.05）.The incidence of perioperative DGF and the incidence of postoperative lung infection and acute rejection in the DD group and LD group were 29.1%（41/141）and 4.4%（5/113）,23.4%（33/141）And 3.5%（4/113）,14.9%（21/141）and 8.0%（9/113）,the differences were statistically significant（χ~2=25.707,19.889 and 4.637,all P<0.05）.As of July 31,2020,the average follow-up time for the LD group was（30±7）months,and for the DD group was（25±11）months.The transplanted kidney loss rate in the DD was 11.3%（16/141）,and LD group was 0.The difference was statistically significant（χ~2=13.685,P<0.05）.The cumulative survival rate of recipients in the DD group was 86.3%,and the LD group was 96.5%,the difference was statistically significant（χ~2=6.87,P<0.05）.Conclusions:donation after DD is currently the main source of donor kidneys,but its short-term clinical effect after surgery is worse than that of LD kidney transplantation.The short-term clinical effect of DD kidney transplantation should be improved in terms of improving the quality of the donor kidney,reducing renal ischemia and reperfusion injury,and rigorously selecting recipients.