Guidelines for clinical diagnosis and treatment of delayed graft function in kidney transplant recipients in China
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摘要: 肾移植受者移植物功能延迟恢复是肾脏移植术后常见的早期并发症之一,是影响移植肾近期和远期存活的独立危险因素。中华医学会器官移植学分会和中国医疗保健国际交流促进会肾脏移植学分会组织国内器官移植与相关学科知名专家在《肾移植术后移植物功能延迟恢复诊疗技术规范(2019版)》的基础上经过指南范围及临床问题的确定、证据检索与筛选及推荐意见的形成等程序编写、多轮讨论,并经学会组织两轮集体审定,最终形成《中国肾脏移植受者移植物功能延迟恢复临床诊疗指南》。本指南就移植肾功能延迟恢复的概念和发生机制、危险因素、诊断、预防、治疗及免疫抑制药应用几个方面的21个临床问题提出推荐意见和推荐意见说明。目的是使肾移植术后受者移植物功能延迟恢复的诊断、预防和治疗规范化,提高肾脏移植效果,提高肾脏移植受者和移植肾近期和长期存活率,促进移植学科的发展。Abstract: Delayed graft function in kidney transplant recipients is one of the common early complications after kidney transplantation, which is an independent risk factor affecting the short-term and long-term survival of renal allografts. Branch of Organ Transplantation of Chinese Medical Association and Branch of Kidney Transplantation of China International Exchange and Promotive Association for Medical and Health Care organized well-known Chinese experts in organ transplantation and related disciplines to formulate and discuss the determination of the scope and clinical problems, evidence retrieval and screening, and the formation of recommendations based on “Technical Specification for the Diagnosis and Treatment on Delayed Graft Function After Renal Transplantation (2019 edition)”. After two rounds of collective examination and approval by Chinese Medical Association and China International Exchange and Promotive Association for Medical and Health Care, “Guidelines for Clinical Diagnosis and Treatment of Delayed Graft Function in Kidney Transplant Recipients in China” was finally formulated. This guideline puts forward recommendations and explanations regarding 21 clinical problems including the concept, mechanism, risk factors, diagnosis, prevention, treatment and application of immunosuppressive drugs for delayed graft function in kidney transplant recipients, aiming to standardize the diagnosis, prevention and treatment of delayed graft function in kidney transplant recipients, enhance clinical efficacy of kidney transplantation, prolong short-term and long-term survival of kidney transplant recipients and renal allografts and promote the development of the discipline of transplantation.
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Key words:
- Kidney transplantation /
- Delayed graft function /
- Diagnosis /
- Treatment /
- Prevention /
- Immunosuppressant
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表 1 2009牛津大学证据分级与推荐意见强度分级标准
Table 1. Level of evidence and recommended strength grades of Oxford University in 2009
推荐强度 证据等级 描述 A 1a RCT的系统评价 1b 结果可信区间小的RCT 1c 显示“全或无效应”的任何证据 B 2a 队列研究的系统评价 2b 单个队列研究(包括低质量的RCT,
如失访率>20%者)2c 基于受者结局的研究 3a 病例对照研究的系统评价 3b 单个病例对照研究 C 4 病例系列报告、低质量队列研究和
低质量病例对照研究D 5 专家意见(即无临床研究支持的仅依据
基础研究或临床经验的推测)表 2 美国器官共享联合网络制定的器官维护目标
Table 2. Organ maintenance goals set by the United States Organ Sharing Network
指标 维护目标 平均动脉压 60~110 mmHg 中心静脉压 4~12 mmHg 射血分数 >50% 低剂量血管升压类药物 种类≤1种。低剂量:多巴胺<10 μg/(kg·min),去氧肾上腺素<1 μg/(kg·min),去甲肾上腺素<0.2 μg/(kg·min),排除使用肾上腺素 动脉血气分析 pH值7.3~7.5 氧合指数 >300 mmHg 血钠 <155 mmol/L 血糖 <180 mg/dL(10 mmol/L) 尿量 过去4 h内,>0.5 mL/(kg·h) -
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