Clinical Research Of Complications After DCD Renal Transplantation

Objective:To investigate the clinical feature and risk factors on complications after DCD renal transplantation,in order to provide the evidence of diagnosis,prevention and treatment of complications.Method:The clinical data of 318 renal transplant recipients(includes 235 DCD renal transplant recipients and 83 live-related donor kidney transplant recipients)in Fuzhou General Hospital of Nanjing Military Command from January 2014 to December 2016 were studied retrospectively.The following cases were excluded:cases without complete information,cases after second or multiple transplants.Cases with infection before renal transplantation were also excluded in the study of infection.According to the standards of diagnosis,patients were divided respectively into group with or without postoperative complications.Clinical data were collected as follows: Preoperative data: ID,admission number,sex,age,blood type,protopathy,duration of peritoneal dialysis or hemodialysis,source of the donor kidneys and the blood type of the donor.Operative data: date of the operation,procedures of the surgery,cold ischemic time and warm ischemic time of the donor kidneys,method of anastomose of the renal vein and anastomose of the renal artery,method of reconstruction of the urinary tract.Postoperative data: scheme of immunosuppression and anti-infection,whether incision complication,urinary complication,infection,acute rejection was diagnosed,the time,clinical manifestation,degree,diagnostic method,treatment and outcome of the complications.Statistical analysis: Data were analysed by using SPSS 24.0 software.Frequency and percentage were calculated.The measurement data whichsubordinate to the normal distribution law were described as(±).Themeasurement data which subordinate to normality and homogeneity of variance were compared with chi-square test between the two groups and described as frequency.P<0.05 was considered as statistical significance.Results:This study includes 235 DCD renal transplant cases and 83 live-related donor kidney transplant cases(male 241,female 77)that ages from 15 years old to 62 years old with the average age of 37.23±10.82 years.In respect of protopathy,they contained 192 cases of chronic glomerulonephritis,43 cases of hypertensive nephropathy,37 cases of diabetic nephropathy,14 cases of polycystic kidney,11 cases of IgA nephropathy and 21 cases of unknown etiology.The warm ischemic time of DCD donor kidney is less than 10 minutes,and the cold ischemic time is less than 12 hours.The warm ischemic time of live-related donor kidney is less than 3 minutes,and the cold ischemic time is less than 2 hours.Complications of318 patients after renal transplantation:1.Incision complications occurred in 13 patients(4.08%)among 318 cases(DCD renal transplantation 9,live-related donor kidney transplantation 4),including 7 cases of incision dehiscence,4 cases of incision infection,2 cases of delayed incision healing.2.Urinary complications occurred in 7 patients(2.20%)among 318 cases(DCD renal transplantation 5,live-related donor kidney transplantation 2),including 4 cases of urinary leak,2 cases of ureteral calculus,1 case of ureteral obstruction.3.Infection occurred in 142 patients(44.65%)among 318 cases(DCD renal transplantation 115,live-related donor kidney transplantation 27),including 92 cases of pulmonary infection,23 cases of urinary tract infection,17 cases of gastrointestinal infection,6 cases of herpes zoster,4 cases of incision infection.72 cases of infection occurred within 2-6 month after renal transplantation.The complication with highest incidence within first month after renal transplantation ispulmonary infection,followed by gastrointestinal infection,incision infection.The complication with highest incidence within 2nd-6th month after renal transplantation is pulmonary infection,followed by urinary tract infection,herpes zoster.The complication with highest incidence after 6 months of renal transplantation is pulmonary infection,followed by urinary tract infection,gastrointestinal infection.27 cases of severe pneumonia occurred among 92 cases of pulmonary infection and 6 patients were dead,while 1 patient was dead in non-infection group.4.DGF occurred in 47 patients(14.78%)among 318 cases(DCD renal transplantation 41,live-related donor kidney transplantation 6).5.Acute rejection occurred in 29 patients(9.12%)among 318 cases(DCD renal transplantation 22,live-related donor kidney transplantation 7).Conclusions:1.Infection and severe pneumonia won the first of morbidity and fatality rate of all complications which counted for 44.65% and 22.22% in our research center.Most of complications occurred within six months after renal transplantation.2.Incision complication was mainly caused by the recipient factors.Age,weight,diabetes,high blood pressure and hypoproteinemia were risk factors of incision complication.No correlation between the incidence of incision complication and the source of donor kidney was observed.Most incision complications can be cured,the prognosis is good.3.Urinary complication was mainly caused by the surgical factors.The incidence rate of urinary complication in DCD renal transplantation group an live-related donor kidney transplantation group were similar.Most of urinary leak can be cured by conservative treatment.To diagnosis ureteral calculus,ultrasonography was essential.Prompt operation is the key of successful treatments.4.The incidence rate of pulmonary infection in DCD renal transplantation group was higher than live-related donor kidney transplantation group,whichmeans the source of donor kidney was an important risk factor.Infection has both high morbidity and fatality rate and most of the case got infected in lung.Most of the infection occurred within 2nd-6th month after renal transplantation and as days go by,its incidence got decreased.Infection after renal transplantation was clinically nontypical.To diagnosis infection,nontypical clinical feature combining the examination of pathogeny was essential.Infection group got higher mortality than non-infection group.5.The incidence of DGF was related to a variety of factors.The incidence rate of DGF in DCD renal transplantation group was higher than live-related donor kidney transplantation group.Shortening warm ischemic time and cold ischemic time was an effective measure to reduce the occurrence of DGF.Most of DGF can be relieved by active treatment.6.The incidence rate of acute rejection between DCD renal transplantation group and live-related donor kidney transplantation group were nonsignificant.Acute rejection after renal transplantation was clinically nontypical.Most of the acute rejection occurred within first month after renal transplantation and as days go by,its incidence got decreased.The effective method of preventing and combating acute rejection were timely recognizing and diagnosing it,and change the scheme of immunosuppression if necessary.