Clinical technical operation specification for living donor kidney transplantation (2019 edition)
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摘要: 为了进一步规范活体肾移植的临床技术操作,中华医学会器官移植学分会组织器官移植学专家从活体肾移植的基本原则、活体供肾者的医学评估和选择、活体肾移植受者的评估、活体供肾切取术等方面,制订本规范。
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表 1 需了解供肾捐献者的病史内容
Table 1. The disease history of kidney donors need to understand
分类 需了解的供者病史内容 心血管病史 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 血液系统疾病史 血友病等 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;AIDS患者和HIV携带者及其性伴侣;HTLV-1和HTLV-2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或非典型分枝杆菌感染;梅毒;有传染病疫区长期居住病史 内分泌及代谢性疾病史 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;卡波齐肉瘤;其他重要脏器的恶性肿瘤(肝癌、肺癌等) 明确的慢性肾脏疾病史 包括可能影响捐献者的肾病家族史以及血尿、肾性水肿、泌尿系统感染;双侧肾结石和高复发类型的肾结石 物质依赖史 吸烟和药物或酒精成瘾病史,吸毒者 精神病与神经病史 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史 疟疾、蠕虫以及其他地方性传染性疾病 妇产科病史 妇产科慢性疾病病史 AIDS为获得性免疫缺陷综合征;HIV为人类免疫缺陷病毒;HTLV为人类T淋巴细胞病毒 表 2 供肾捐献者的常规筛查项目
Table 2. Routine screening program of kidney donors
分类 检查项目 一般情况 BMI,血压 尿液检查 蛋白、血细胞和尿糖检测
显微镜检查
细菌培养和药物敏感性测定(≥2次,如有指征)
蛋白排泄率测定(如有指征)大便检查 大便潜血实验 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
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 HBV和HCV标志物
HIV
HTLV-1和HTLV-2(如有指征)
巨细胞病毒
EB病毒
梅毒
水痘-带状疱疹病毒(若受者血清学阴性)
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)
肾小球滤过率腹腔脏器 腹部超声 心血管及呼吸系统 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;HBV为乙型肝炎病毒;HCV为丙型肝炎病毒;HIV为人类免疫缺陷病毒;HTLV为人类T淋巴细胞病毒 -
[1] 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. DOI: 10.1111/ajt.13195. [2] 中山医学院第一附属医院外科.同种异体肾移植1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 allogeneic renal transplantation in 1 case[J]. New Med, 1974, 5(12):593. [3] 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. DOI: 10.3760/cma.j.issn.0254-1785.2000.01.012.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. DOI: 10.3760/cma.j.issn.0254-1785. 2000.01.012. [4] 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.Branch of Organ Transplantation of Chinese Medical Association, Branch of Organ Transplant Physician of Chinese Medical Doctor Association. Clinical guideline on live donor renal transplantation in China (2016 edition)[J]. Organ Transplant, 2016, 7(6):417-426. DOI: 10.3969/j.issn.1674-7445.2016.06.002. [5] LENTINE KL, KASISKE BL, LEVEY AS, et al. KDIGO clinical practice guideline on the evaluation and care of living kidney donors[J]. Transplantation, 2017, 101(8S Suppl 1): S1-S109. DOI: 10.1097/TP.0000000000001769. [6] British Transplantation Society. BTS/RA living donor kidney transplantation guidelines 2018: guidelines for living donor kidney transplantation (fourth edition)[EB/OL]. (2018-03-01). https://bts.org.uk/wp-content/uploads/2018/07/FINAL_LDKT-guidelines_June-2018.pdf. [7] 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. [8] 中华人民共和国国务院.人体器官移植条例[EB/OL]. (2007-03-31). http://www.nhc.gov.cn/wjw/flfg/200804/d0e7200bc48a4b45b26a50a63325e029.shtml. [9] 王显丁, 邱阳, 宋涂润, 等.ABO血型不相容亲属活体肾移植的个体化预处理[J].中华器官移植杂志, 2015, 36(8):449-452.DOI: 10.3760/cma.j.issn.0254-1785.2015.08.001.WANG XD, QIU Y, SONG TR, et al. Application of individualized protocols in ABO-incompatible living donor kidney transplantation[J]. Chin J Organ Transplant, 2015, 36(8):449-452. DOI: 10.3760/cma.j.issn.0254-1785.2015.08.001. [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] 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/j.1600-6143.2007.01932.x [12] Working Party of the British Transplantation Society and the Renal Association. United Kingdom guidelines for living donor kidney transplantation (3rd edition)[C]. London: British Transplantation Society, 2011. [13] TANGDHANAKANOND K, MANDELBROT D. Evaluation of high-risk living kidney donors[J]. Front Biosci (Elite Ed), 2015, 7:158-167. https://www.ncbi.nlm.nih.gov/pubmed/25553371 [14] POGGIO ED, BRAUN WE, DAVIS C. The science of Stewardship: due diligence for kidney donors and kidney function in living kidney donation--evaluation, determinants, and implications for outcomes[J]. Clin J Am Soc Nephrol, 2009, 4(10):1677-1684. DOI: 10.2215/CJN.02740409. [15] DELMONICO F, Council of the Transplantation Society. A report of the amsterdam forum on the care of the live kidney donor: data and medical guidelines[J]. Transplantation, 2005, 79(6 Suppl): S53-S66. http://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_PM15785361 [16] 陈实, 石炳毅.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. [17] 中华医学会器官移植学分会, 中华医学会泌尿外科学会肾移植学组. "活体供肾移植"博鳌会议共识[M].香港:华夏科学出版社, 2008. [18] MOGULLA MR, BHATTACHARJYA S, CLAYTON PA. Risk factors for and outcomes of delayed graft function in live donor kidney transplantation - a retrospective study[J]. Transpl Int, 2019, DOI: 10.1111/tri.13472[Epubahead of print]. [19] MAGGIORE U, BUDDE K, HEEMANN U, et al. Long-term risks of kidney living donation: review and position paper by the ERA-EDTA DESCARTES working group[J]. Nephrol Dial Transplant, 2017, 32(2):216-223. DOI: 10.1093/ndt/gfw429. [20] 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. [21] MUZAALE AD, MASSIE AB, KUCIRKA LM, et al. Outcomes of live kidney donors who develop end-stage renal disease[J]. Transplantation, 2016, 100(6):1306-1312. DOI: 10.1097/TP.0000000000000920. [22] TIETJEN A, HAYS R, MCNATT G, et al. Billing for living kidney donor care: balancing cost recovery, regulatory compliance, and minimized donor burden[J]. Curr Transplant Rep, 2019, 6(2):155-166. DOI: 10.1007/s40472-019-00239-0. [23] HAYS RE, LAPOINTE RUDOW D, DEW MA, et al. The independent living donor advocate: a guidance document from the American Society of Transplantation's Living Donor Community of Practice (AST LDCOP)[J]. Am J Transplant, 2015, 15(2):518-525. DOI: 10.1111/ajt.13001. [24] LIYANAGE L, MUZAALE A, HENDERSON M. The true risk of living kidney donation[J]. Curr Opin Organ Transplant, 2019, 24(4):424-428. DOI: 10.1097/MOT.0000000000000654.
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