Compare And Analysis The Clinical Results Between Living Related Donor And Cadaveric Donor Renal Transplantation

PartⅠCompare and Analysis the Clinical Results between Living Related Donor and Cadaveric Donor Renal TransplantationObjective:To compare and analysis the clinical results between living related donor and cadaveric donor renal transplantation.Mehtods:Retrospective compare and analyze the clinical data of 26 cases living related donor renal transplantation and 92 cases cadaveric donor renal transplantation in the corresponding time period.Compare the recovery result of renal function, the suage of ciclosporin(CSA) in 1 month during post-operation; the incidence rate of acute rejection and pulmonary infection in the 1 year during post-operation; the renal function(serum creatinine) and the survival rate of human/renal in 1 month, 3 month, 6 month, 1 year during post-operation.Result:26 cases living related donor have no complication, the renal function is normal, the living and working have been uninfluenced during post-operation. The velocity of renal function recovery of recipient: the living related donor renal transplantation is 286.11±81.33μmol/L/day, the cadaveric donor renal transplantation is 136.63±78.79μmol/L/day(P<0.01);the optimum value of renal function recovery: the living related donor renal transplantation is 83.24±20.91μmol/L, the cadaveric donor renal transplantation is 108.23±28.56μmol/L(P<0.01);the suage of ciclosporin(CsA) in 1 month during post-operation : the living related donor renal transplantation is 5.87±0.82 mg/kg/day, the cadaveric donor renal transplantation is7.49±1.12mg/kg/day(P<0.05);the incidence rate of acute rejection and pulmonary infection in the 1 year during post-operation :the living related donor renal transplantation is 3.85%,7.69%,the cadaveric donor renal transplantation is 28.26%,31.52%(P<0.05);the survival rate of human/renal in 1 month, 3 month, 6 month, 1 year during post-operation: the living related donor renal transplantation is 100%/100%,96.15%/96.15%,92.31%/92.31%,92.31%/92.31%,88.46%/88.46%,the cadaveric donor renal transplantation is 91.30%/84.78%,89.13%/82.61%,84.78%/78.26%,82.61%/76.09%,81.52%/72.83% (P<0.05);the renal function(serum creatinine) in 1 month, 3 month, 6 month, 1 year during post-operation: the living related donor renal transplantation is 92.4±13.2(μmol/L),95.6±13.7(μmol/L),98.2±15.4(μmol/L),113.2±17.8(μmol/L),131.2±19.3(μmol/L),the cadaveric donor renal transplantation is 109.4±16.7(μmol/L),114.5±18.2(μmol/L),119.3±19.1(μmol/L),122.5±18.3(μmol/L),138.6±21.3(μmol/L)(P<0.05)。ConclusionThe recovery of renal function and the survival rate of man /renal of living related donor renal transplantation is surpass to the cadaveric donor renal transplantation, the usage of immunosuppressive and the incidence rate of acute rejection and pulmonary infection is lower than cadaveric donor renal transplantation. In the whole, the clinical results of living related donor renal transplantation is surpass to cadaveric donor renal transplantation, the living related donor renal transplantation is safety and effectual in clinically. PartⅡThe Cause and Treatment of the Severe Pulmonary Infection after Renal TransplantationObjectiveTo investigate the cause and treatment of the severe pulmonary infection after renal transplantation.MethodsA total of 29 cases severe pulmonary infection after transplantation were retrospectively analyzed.ResultsAmong the 29 cases, the pathogens of pulmonary infection were bacteria(2 cases), bacillus tuberculosis(2 cases), fungus(3 cases), cytomegalovirus(2 cases), mixed infection(14 cases), and there was no pathogen found in 6 patients.All of the severe pulmonary infection patients were happened within 6 months after renal transplantation. 17 cases out of the 29 severe pulmonary infection patients(58.6%) were rescued successfully,and 12 (41.4%)died from acute respiratory distress syndrome.ConclusionIt is within 6 months after renal trnasplantation that recipients consistently encounter high frequency of severe pulmonary infection that are difficult to diagnose, progress rapidly, and have worse prognosis, which require systematic treatment and high cost. Intensive care and active measures should be given in the treatment of severe pulmonary infection after renal transplantation. The key points of successful treatment involve the early identification of pathogens, administration of extended-spectrum and combined antibiotics, aggressive reduction or discontinuation of the immunosuppression therapy, correction of hypoxia and hypoproteinemia.