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中华医学会器官移植学分会, 中国医师协会器官移植医师分会. 中国活体供肾移植临床指南(2016版)[J]. 器官移植, 2016, 7(6): 417-426. doi: 10.3969/j.issn.1674-7445.2016.06.002
引用本文: 中华医学会器官移植学分会, 中国医师协会器官移植医师分会. 中国活体供肾移植临床指南(2016版)[J]. 器官移植, 2016, 7(6): 417-426. doi: 10.3969/j.issn.1674-7445.2016.06.002
Clinical guideline on living donor renal transplantation in China (2016 edition)[J]. ORGAN TRANSPLANTATION, 2016, 7(6): 417-426. doi: 10.3969/j.issn.1674-7445.2016.06.002
Citation: Clinical guideline on living donor renal transplantation in China (2016 edition)[J]. ORGAN TRANSPLANTATION, 2016, 7(6): 417-426. doi: 10.3969/j.issn.1674-7445.2016.06.002

中国活体供肾移植临床指南(2016版)

doi: 10.3969/j.issn.1674-7445.2016.06.002
基金项目: 

国家自然科学基金 81370578、81570680

详细信息
  • 中图分类号: R617

Clinical guideline on living donor renal transplantation in China (2016 edition)

  • 摘要: 活体供肾移植经历半个多世纪的发展,已成为终末期肾病患者的重要治疗手段。在我国,亲属活体器官捐献肾移植作为家庭自救的方式之一,近年来已成为肾脏供体来源的重要补充部分。本指南以世界卫生组织《人体器官移植指导原则》(1991)、中华人民共和国国务院《人体器官移植条例》(2007)以及国家卫生部《关于规范活体器官移植的若干规定》(2010)为法律依据,在《中国活体供肾移植指南》(2009)的基础上进行更新。内容包括活体供肾移植的伦理学、供者与受者的医学评估、活体供肾摘取原则与手术方式、供者近期与远期并发症以及供者的长期随访等。

     

  • 表  1  需要了解供肾意向供者的病史内容

    Table  1.   The disease history of intended kidney donors need to understand

    需了解的意向供者病史内容
    ● 心血管病危险因素
    缺血性心肌病、外周血管疾病、动脉硬化;高血压;血栓栓塞性疾病;血友病
    ● 传播性感染病史
    肝炎或黄疸;输血;静脉注射吸毒;6个月内纹身或皮肤穿孔;HIV患者和HIV携带者及其性伴侣; HTLV1和HTLV2感染的高危人群;巨细胞病毒等病毒感染;慢性感染性疾病如结核、非典型分枝杆菌感染;梅毒;有传染病疫区长期居住史
    ● 糖尿病包括糖尿病家族史;代谢综合征及其他严重的代谢系统疾病;痛风
    ● 恶性肿瘤病史
    黑色素瘤;睾丸癌;肾细胞癌;绒毛膜癌;血液系统恶性肿瘤;支气管癌;乳腺癌;单克隆丙种球蛋白病;卡波济氏肉瘤
    ● 明确的慢性肾脏疾病
    包括可能影响捐赠者的肾病家族史以及血尿、肾性水肿、泌尿系感染;双侧肾结石和高复发类型的肾结石
    ● 吸烟和药物或酒精成瘾病史,吸毒者
    ● 精神病史,应用生长激素病史以及未明确诊断的神经障碍病史
    ● 慢性真菌和寄生虫感染
    疟疾、蠕虫以及其他地方性传染性疾病
    ● 妇产科慢性疾病病史
    注:HIV为人类免疫缺陷病毒;HTLV为人类T淋巴细胞病毒
    下载: 导出CSV

    表  2  供肾意向供者的常规筛查项目

    Table  2.   Routine screening program of intended kidney donors

    项目种类具体内容
    一般情况● BMI,血压
    尿液检查● 蛋白、血细胞和糖试纸检测(≥ 2次)
    ● 显微镜检查
    ● 细菌培养和敏感性测定(≥ 2次,如有指征)
    ● 蛋白排泄率测定(如有指征)
    粪便检查● 粪便隐血试验
    血液检查● 血红蛋白和血细胞计数
    ● 凝血筛查(PT和APTT)
    ● 肝、肾功能及电解质
    ● 空腹血糖
    ● 口服葡萄糖耐量试验(若有糖尿病家族史或空腹血糖>5.6 mmol/L)
    病毒学和感染筛查● 乙型肝炎病毒和丙型肝炎病毒标志物
    ● HIV
    ● HTLV1和HTLV 2(如有指征)
    ● 巨细胞病毒
    ● EB病毒
    ● 弓形虫
    ● 梅毒
    ● 水痘-带状疱疹病毒(若受者为血清学阴性)
    ● 人类疱疹病毒8型(如有指征)
    肾脏解剖和功能评估● 超声和CT(包括三维重建)
    ● ECT测量双侧肾小球滤过率(GFR)
    腹腔脏器● 腹部超声
    心血管呼吸系统● 胸部X线摄片
    ● 心电图
    ● 超声心动图(如有指征)
    ● 心血管负荷试验(作为常规或如有指征时)
    肿瘤筛查● 肿瘤标志物
    ● 女性行乳腺超声和X线摄片、宫颈涂片
    注:BMI为体质量指数;PT为凝血酶原时间;APTT为活化部分凝血活酶时间;HIV为人类免疫缺陷病毒;HTLV为人类T淋巴细胞病毒;ECT为发射型计算机断层摄影术
    下载: 导出CSV
  • [1] Legendre Ch, Kreis H. A tribute to Jean Hamburgers contribution to organ transplantation[J]. Am J Transplant,2010,10(11):2392-2395. doi: 10.1111/ajt.2010.10.issue-11
    [2] Murray JE, Tilney NL, Wilson RE. Renal transplantation: a twenty-five year experience[J]. Ann Surg, 1976,184(5):565-73. doi: 10.1097/00000658-197611000-00006
    [3] 中山医学院第一附属医院外科. 同种异体肾移植一例临床报道[J]. 新医学, 1974,5(12):593-596.

    Department of Surgery in the First Affiliated Hospital of Zhongshan Medical College. Clinical report of allograft renal transplantation in 1 case[J]. New Med, 1974,5(12):593-596.
    [4] 林正斌,曾凡军,刘斌,等. 同卵孪生姐妹间肾移植一例报告[J].中华器官移植杂志,2000,21(1):33-34. http://www.cnki.com.cn/Article/CJFDTOTAL-ZHQG200001015.htm

    Lin ZB, Zeng FJ, Liu B, et al. One case report:renal transplantation between the identical-twin sister[J]. Chin J Organ Transplant,2000,21(1):33-34. http://www.cnki.com.cn/Article/CJFDTOTAL-ZHQG200001015.htm
    [5] 石炳毅,蔡明,钱叶勇,等.亲属活体供肾移植的相关伦理学问题与实践[J].中华医院管理杂志,2007,23(12):839-842. http://www.cnki.com.cn/Article/CJFDTOTAL-ZHWK200312001.htm

    Shi BY, Cai M, Qian YY, et al. Living-related donor kidney transplantation: ethical problems and practice[J]. Chin J Hosp Admin,2007,23(12):839-842. http://www.cnki.com.cn/Article/CJFDTOTAL-ZHWK200312001.htm
    [6] Ethics Committee of the Transplantation Society. The consensus statement of the amsterdam forum on the care of the live kidney donor[J]. Transplantation, 2004, 78(4):491-492. doi: 10.1097/01.TP.0000136654.85459.1E
    [7] 陈忠华. 提倡亲属活体肾移植力推“家庭内自救”方案[J].肾脏病与透析肾移植杂志,2006,15(1):47-48. http://www.cnki.com.cn/Article/CJFDTOTAL-SZBY200601008.htm

    Chen ZH. Encouraging living-related kidney transplantation and promoting family-salvage program[J]. Chin J Nephrol Dial Transplant,2006,15(1):47-48. http://www.cnki.com.cn/Article/CJFDTOTAL-SZBY200601008.htm
    [8] Matas AJ, Smith JM, Skeans MA, et al. OPTN/SRTR 2013 Annual Data Report: kidney[J]. Am J Transplant,2015,15(Suppl 2):1-34. https://www.ncbi.nlm.nih.gov/pubmed/25626344
    [9] Kohei N, Hirai T, Omoto K, et al. Chronic antibody-mediated rejection is reduced by targeting B-cell immunity during an introductory period[J]. Am J Transplant,2012,12(2):469-476. doi: 10.1111/j.1600-6143.2011.03830.x
    [10] Lefaucheur C, Loupy A, Hill GS, et al. Preexisting donor-specific HLA antibodies predict outcome in kidney transplantation[J]. J Am Soc Nephrol, 2010, 21(8):1398-1406. doi: 10.1681/ASN.2009101065
    [11] el-Diasty TA, Shokeir AA, el-Ghar ME, et al. Contrast enhanced spiral computerized tomography in live kidney donors: a single session for anatomical and functional assessment[J]. J Urol,2004,171(1):31-34. doi: 10.1097/01.ju.0000099784.52825.8e
    [12] Grewal GS, Blake GM. Reference data for 51Cr-EDTA measurements of the glomerular filtration rate derived from live kidney donors[J]. Nucl Med Commun,2005,26(1):61-65. doi: 10.1097/00006231-200501000-00010
    [13] Fleming JS, Zivanovic MA, Blake GM, et al. Guidelines for the measurement of glomerular filtration rate using plasma sampling[J]. Nucl Med Commun, 2004, 25(8):759-769. doi: 10.1097/01.mnm.0000136715.71820.4a
    [14] Mandelbrot DA, Pavlakis M, Danovitch GM, et al. The medical evaluation of living kidney donors: a survey of US transplant centers[J]. Am J Transplant, 2007, 7(10):2333-2343. doi: 10.1111/ajt.2007.7.issue-10
    [15] Working Party of the British Transplantation Society and the Renal Association. United Kingdom guidelines for living donor kidney transplantation[M]. 3rd ed. London: British Transplantation Society, 2011.
    [16] Tangdhanakanond K, Mandelbrot D. Evaluation of high-risk living kidney donors[J]. Front Biosci, 2015,7: 158-167. http://cn.bing.com/academic/profile?id=1966291032&encoded=0&v=paper_preview&mkt=zh-cn
    [17] Delmonico F, Council of the Transplantation Society. A report of the amsterdam forum on the care of the live kidney donor: data and medicalguidelines[J]. Transplantation, 2005, 79(6 Suppl):S53-S66. http://www.nieren-transplantation.com/fileadmin/documents/guideline_Lebendnierenspender_2004.pdf
    [18] 中华医学会. 临床技术操作规范器官移植分册[M]. 北京: 人民军医出版社,2010: 10-11.
    [19] Moore DR, Feurer ID, Zaydfudim V, et al. Evaluation of living kidney donors: variables that affect donation[J]. Prog Transplant, 2012, 22(4):385-392. doi: 10.7182/pit2012570
    [20] 中华医学会器官移植学分会, 中华医学会泌尿外科学分会肾移植学组. “活体供肾移植”博鳌会议共识[M]. 香港: 华夏科学出版社, 2008.
    [21] Matas AJ, Bartlett ST, Leichtman AB, et al. Morbidity and mortality after living kidney donation, 1999-2001: survey of United States transplant centers[J]. Am J Transplant, 2003, 3(7):830-834. http://cn.bing.com/academic/profile?id=2168782052&encoded=0&v=paper_preview&mkt=zh-cn
    [22] Segev DL, Muzaale AD, Caffo BS, et al. Perioperative mortality and long-term survival following live kidney donation[J]. JAMA,2010,303(10):959-966. doi: 10.1001/jama.2010.237
    [23] Ibrahim HN, Foley R, Tan L, et al. Long-term consequences of kidney donation[J]. N Engl J Med,2009, 360(5):459-469. doi: 10.1056/NEJMoa0804883
    [24] Fehrman-Ekholm I, Elinder CG, Stenbeck M, et al. Kidney donors live longer[J]. Transplantation, 1997,64(7):976-978. doi: 10.1097/00007890-199710150-00007
    [25] Mjøen G, Hallan S, Hartmann A, et al. Long-term risks for kidney donors[J]. Kidney Int, 2014,86(1):162-167. doi: 10.1038/ki.2013.460
    [26] Muzaale AD, Massie AB, Wang MC, et al. Risk of end-stage renal disease following live kidney donation[J]. JAMA, 2014, 311(6):579-586. doi: 10.1001/jama.2013.285141
    [27] Garg AX, Nevis IF, McArthur E, et al. Gestational hypertension and preeclampsia in living kidney donors[J]. N Engl J Med, 2015, 372(2): 124-133. doi: 10.1056/NEJMoa1408932
    [28] Living Kidney Donor Follow-Up Conference Writing Group, Leichtman A, Abecassis M, et al. Living kidney donor follow-up: state-of-the-art and future directions, conference summary and recommendations[J]. Am J Transplant, 2011, 11(12):2561-2568. doi: 10.1111/j.1600-6143.2011.03816.x
    [29] Schold JD, Buccini LD, Rodrigue JR, et al. Critical factors associated with missing follow-up data for living kidney donors in the United States[J]. Am J Transplant,2015,15(9):2394-2403. doi: 10.1111/ajt.v15.9
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出版历程
  • 收稿日期:  2016-08-10
  • 网络出版日期:  2021-03-19
  • 刊出日期:  2016-11-15

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