中国肾脏移植受者移植物功能延迟恢复临床诊疗指南

中华医学会器官移植学分会; 中国医疗保健国际交流促进会肾脏移植学分会; 项和立; 王玮; 王建宁; 徐小松; 王钢; 薛武军

doi:10.3969/j.issn.1674-7445.2024156

中国肾脏移植受者移植物功能延迟恢复临床诊疗指南

doi: 10.3969/j.issn.1674-7445.2024156

1.
710061　西安，西安交通大学第一附属医院
2.
首都医科大学附属北京朝阳医院
3.
山东第一医科大学第一附属医院
4.
陆军军医大学西南医院
5.
吉林大学第一医院

基金项目: 国家自然科学基金（82370802）；陕西省卫生健康肾脏移植科研创新平台（2023PT-06）

详细信息

通讯作者:
薛武军，Email：xwujun126@xjtu.edu.cn

中图分类号: R617, R692
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- 文章访问数: 90
- HTML全文浏览量: 44
- PDF下载量: 23
- 被引次数: 0
出版历程
- 收稿日期: 2024-05-22
- 网络出版日期: 2024-06-07

Guidelines for clinical diagnosis and treatment of delayed graft function in kidney transplant recipients in China

1.
The First Affiliated Hospital of Xi'an Jiaotong University, Xi 'an 710061, China

More Information

Corresponding author: Xue Wujun, Email: xwujun126@xjtu.edu.cn

摘要

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。
- 肾脏移植 /
- 移植物功能延迟恢复 /
- 诊断 /
- 治疗 /
- 预防 /
- 免疫抑制药
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.
- 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）

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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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