Clinical Analysis Of Donors And Recipients Of Kidney Transplantation From Living And DCD Donors In Single Center

Part I Clinical analysis of renal transplantation from living relatives and Donation after Cardiac Death donorsObjective: To compare the clinical effects of relative living donor kidney and donation after cardiac death(DCD)donor kidney transplantation.Methods: A retrospective analysis was performed on the clinical data of 45 cases of relative living donor kidney and 21 cases of DCD donor renal transplantation performed by the Department of Kidney Transplantation of Lanzhou University Second Hospital from April 2011 to January 2018.compare the general conditions,complications,renal function and cumulative survival rate of human kidney in the two groups of patients.Result: There was no significant difference in gender,BMI,operation time,length of postoperative hospital stay,etc.between the two groups.There was a significant difference in age and dialysis time between the two groups;There were 2 cases(4.4%)and 6 cases(28.6%)of acute rejection in the relative living and DCD donor kidney group,The difference between the two groups was statistically significant.Delayed recovery of renal function occurred in 1 cases(2.2%)and 2 cases(9.5%)respectively.There was no significant difference between the two groups.By comparing preoperative and postoperative serum creatinine levels between the two groups of patients,the difference in serum creatinine between the two groups was statistically significant within the first week after surgery.The time difference between the recovery of normal serum creatinine was statistically significant;There was no statistically significant difference in serum creatinine between the two groups at 2 weeks,1 month,and 2 months after surgery.There was no significant difference in the cumulative survival rate of the human kidney between the relative living donor kidney group and the DCD donor kidney group during the entire follow-up period.Conclusion : The early effects of living relatives and DCD for kidney transplantation are similar.Relative living donor kidney transplantation has certain advantages in acute rejection and short-term recovery of renal function after transplantation,but the cumulative survival rate of human kidney during follow-up is the same.Part II Clinical analysis of hand-assisted retroperitoneoscopic and open live donor nephrectomyObjective: To compare the clinical efficacy and safety of hand-assisted retroperitoneoscopic live donor nephrectomy(HRPLDN)and open living donor nephrectomy(ODN).Methods: The clinical data of 43 patients with HRPLDN and 47 patients with ODN in the Second Hospital of Lanzhou University from January 2008 to January 2018 were retrospectively analyzed.The donor’s operation time,warm ischemia time,arteriovenous length,ureter length,incision length and bleeding volume and perioperative complication were compared.The 24 h urine volume,painkillers within 3 days after surgery,hospitalization time and postoperative complications were also compared.At the same time,the renal function indicators and the recovery of donors and recipients at 1 week,1 month and 3 months after surgery were compared.Results: All the 90 donors and all of the transplantations were performed successfully.No intraoperative open access was performed in the HRPLDN group,and the time of warm ischemia in HRPLDN group and ODN group was 92.2±17.5s vs 80.2±16.3s with significant difference(P<0.05).The bleeding volume and incision length of the two groups was 67.9±26.1 ml vs 80.0±25.6 ml and 9.2±1.0 cm vs 13.3±1.6 cm respectively,with significant difference(P < 0.05).Postoperative hospital stay was 5.7±1.7d vs 6.8±2.1d with significant difference(P<0.05).Postoperative analgesia at 3d was given for 1 case and 8 cases respectively,and the difference between the two groups was statistically significant(P<0.05).There was no significant difference in operative time,arteriovenous length,length of ureter and urine volume at 24 hours after operation(P>0.05).There was no significant difference in creatinine levels at 7 days,1 month and 3 months after operation(P>0.05).In the HRPLDN group,there was 1 case of incision fat liquefaction.In the ODN group,incision fat liquefaction occurred in 2 cases and incision infection in 1 case.The number of acute rejection of the HRPLDN group and the ODN group was 2 and 3,respectively.There was 1 case of delayed graft function recovery,and the renal function of the other recipients recovered well.Conclusion: Both HRPLDN and ODN are safe and reliable.Compared with ODN,HRPLDN has less trauma,less bleeding,better cosmetic effect and shorter hospitalization time,which can replace ODN as the preferred treatment.