Abstract:

Objective To investigate the effect of cardiac death organ donation（DCD）for kidneytransplantation in mesangial immunoglobulin A（IgA）deposition. Methods We retrospectively reviewed the renal donation by DCD in Zhengzhou People’s hospital between June 2015 and June 2017. Donors underwentpathological biopsy before surgery. The renal function and graft survival time were compared in mesangial IgA deposition group（IgA DCD group，n ＝ 24）and mesangial no IgA deposition group（no IgA DCD group，n ＝ 68）.Results In 92 cases, IgA deposition was found in 24 cases of mesangial area of donor kidney by pathological before operation. The mean serum creatinine levels at 12th month，24th month after operation were（92.48±9.70）μmol/Land（89.64±7.61）μmol/L in mesangial IgA deposition group，（93.77±8.82）μmol/L and（90.95±7.71）μmol/L in non-mesangial IgA deposition group，respectively. The mean Scr levels in patients at different time points two years after transplantation in two groups were no significantly different. After 12 ～ 36 months of follow-up，Kaplan-meier analysis showed no significant difference in survival rate between two groups. Conclusion There was no significantdifference between two groups on the short-term renal allograft function and allograft survival. The glomerular mesangial IgA deposition in kidney from DCD donors can be used as donor kidney source.

Key words: Kidney transplantation, Immunoglobulin A, Donation after cardiac death

摘要：

目的 探讨系膜免疫球蛋白 A（immunoglobulin A，IgA）沉积的心脏死亡器官捐献（donation after cardiac death，DCD）供肾的移植效果。方法 回顾性分析郑州市人民医院 2015 年 6 月—2017 年 6 月收治的 DCD 供肾肾移植患者的临床资料，进行术前病理活检，比较系膜 IgA 沉积 DCD 供肾（IgA DCD 组，n ＝ 24）与系膜无 IgA 沉积 DCD 供肾（无 IgA DCD 组，n ＝ 68）移植后肾功能、移植肾生存时间等。结果 92 例供肾中术前病理穿刺发现 24 例供肾的系膜区可见 IgA 沉积。检测受者术后 12 个月、24 个月血 肌酐值，IgA DCD 组血肌酐值分别为（92.48±9.70）μmol/L、（89.64±7.61）μmol/L。无 IgA DCD 组血肌酐 值分别为（93.77±8.82）μmol/L、（90.95±7.71）μmol/L。两组 2 年内各个时间点血肌酐值无统计学差异。受体 IgA 复发组接受系膜沉积 IgA DCD 供肾 7 例（50%，7/14），受体 IgA 未复发组接受系膜沉积 IgA DCD供肾 8 例（30%，8/26）, 比较两组接受系膜 IgA 沉积 DCD 供肾分布无统计学意义。随访 12 ～ 36 个月，Kaplan-meier 分析结果表明 IgA DCD 组与无 IgA DCD 组移植肾存活率无统计学意义。结论 系膜 IgA 沉积的 DCD 供肾可用于移植，不影响短期移植肾功能、IgA 肾病复发及移植肾存活率，可作为供肾的来源。

关键词: 肾移植 , 免疫球蛋白 A , 心脏死亡器官捐献