| Background and objectiveIn recent years,the prevalence of chronic kidney disease(CKD)in China has been increasing continuously,and it has become one of the most important diseases endangering public health.If patients with chronic kidney disease didn't accept effective and timely treatment,the disease can progress slowly and eventually progress to end-stage renal disease(ESRD),in which patients need renal replacement therapy,such as hemodialysis,peritoneal dialysis,and kidney transplantation and so on.Kidney transplantation is the first choice for the treatment of choice for end-stage renal disease.Compared with hemodialysis and peritoneal dialysis,kidney transplantation significantly prolongs the survival time and quality of life of patients with end-stage renal disease.In China,the source of kidney supply in the early stage of kidney transplantation is mainly based on the corpse of the judicial system,and the proportion of living kidney transplantation is very small.With the continuous improvement and perfection of the laws and regulations on organ transplantation in China and the gradual standardization of renal transplantation,since January 1,2015,China has prohibited the use of executed prisoners'organs as the source of donors for organ transplantation.Donation after citizen's death(DCD)donors have become the only source of organ transplantation in our country.However,due to the complexity of the primary disease of DCD donors,there are many unpredictable factors compared with living related kidney transplantation,so organ transplantation physicians are required to conduct a comprehensive and effective evaluation of DCD donors.The purpose of this study was to compare and analyze the postoperative condition of DCD kidney transplantation and living related kidney transplantation.MethodsWe retrospectively collected data on 158 patients who underwent allogeneic kidney transplantation from the Department of Organ Transplantation,Qilu Hospital of Shandong University from January 1,2015 to March 31,2018.There were 60 cases in living related kidney transplantation group and 98 cases in the DCD kidney transplantation group.The data we collected included patient gender,age,weight,height,body mass index(BMI),preoperative serum creatinine(Cr),preoperative urea nitrogen(BUN),preoperative serum uric acid(UA),operation time,creatinine levels at different stages after operation,postoperative extubation time,postoperative hospital stay,application of immunosuppressive agents,postoperative complications,one-year survival rate of patients after surgery and one-year survival rate of transplanted kidney.The data were analyzed by SPSS software 23.0.The Kolmogorov—Smirnov test is used to test whether the continuous measurement data obeys the normal distribution.If the normal distribution is obeyed,the independent sample t test is used;the non-normal distribution continuous measurement data is performed by Mann-Whitney U test.The count data is tested by chi-square test or Fisher exact probability method according to the characteristics of the data.Kaplan-Meier survival curves were used to compare the survival of the two groups and the transplanted kidney,and Log-Rank test was used to compare the difference of survival between the two groups.P<0.05 was considered to be statistically significant.ResultsThere was no significant difference in gender composition and preoperative test indicators between the living related kidney transplantation group and the DCDkidney transplantation group(P>0.05).The average age of the patients in the living related kidney transplantation group was younger than that in the DCD kidney transplantation group(P<0.001).The average operation time in DCD kidney transplantation group was significantly shorter than that in living related kidney transplantation group(P<0.001).The average creatinine level in the living related kidney transplantation group was significantly lower than that in the DCD kidney transplantation group within 1 week after operation(P<0.05),but at and after 2weeks after operation,including 1 month,2 months,6 months and 1 year after operation,although the average creatinine level in DCD kidney transplantation group was still higher than that in living related kidney transplantation group,there was no significant difference between the two groups(P>0.05).The postoperative hospital stay in the living related kidney transplantation group was significantly shorter than that in the DCD kidney transplantation group(P = 0.002),but there was no significant difference in postoperative extubation time,one-year survival rate of patients and one-year survival rate of transplanted kidney between the two groups(P>0.05).In terms of postoperative complications,the incidence of delayed graft function(DGF)in the living related kidney transplantation group was significantly lower than that in the DCD kidney transplantation group(P = 0.003),but there was no significant difference in the incidence of acute rejection between the two groups(P>0.05).ConclusionThe recovery rate of renal function in the short-term postoperative period in the living related kidney transplantation group was significantly faster than that in the DCD kidney transplantation group..The incidence of delayed graft function(DGF)in living related kidney transplantation group was significantly lower than that in DCD kidney transplantation group,but in other aspects,there was no significant difference between DCD kidney transplantation and living related kidney transplantation.DCD kidney transplantation is a safe and reliable treatment for patients with end-stage renal disease. |
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