Ghép thận từ người hiến tạng sau khi chết: tỷ lệ sống còn thận ghép và bệnh nhân

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Tác giả: Trọng Hiền Nguyễn, Minh Sâm Thái, Ngọc Sinh Trần

Ngôn ngữ: Vie

Ký hiệu phân loại: 617 Miscellaneous branches of medicine Surgery

Thông tin xuất bản: Tạp chí Y học Việt Nam 2023

Mô tả vật lý: 382-389

Bộ sưu tập: Metadata

ID: 407960

Thêm vào giỏ Liên kết toàn văn

Người hiến tạng (NHT) chết giúp mở rộng nguồn tạng hiến, và đang trở thánh xu hướng ghép tạng trên thế giới, khi nguồn thận từ người sống không đáp ứng nhu cầu. Mục tiêu nghiên cứu: Trình bày tỷ lệ sống còn thận ghép, tỷ lệ sống còn BN nhận thận, và các yếu tố ảnh hưởng đến tỷ lệ sống còn này. Phương pháp nghiên cứu: Nghiên cứu mô tả hàng loạt ca, hồi cứu, bao gồm những trường hợp (TH) nhận thận từ NHT chết, từ tháng 4/2008 đến tháng 12/ 2021, tại bệnh viện Chợ Rẫy. Kết quả và bàn luận: Nghiên cứu có 27 NHT chết, trung vị tuổi 37, giới tính nam chiếm đa số 88,8%. Trung vị KDPI là 35%. 51 TH nhận thận, có trung vị tuổi là 37, nam giới 72,5%, chỉ số khối cơ thể là 20,9, thời gian điều trị thay thế thận là 39,3 tháng, thận nhân tạo là phương pháp chủ yếu, trung vị thời gian thiếu máu lạnh là 7 giờ, thời gian thiếu máu ấm là 38 phút. Thuốc ức chế miễn dịch (UCMD) dẫn nhập chủ yếu là nhóm ức chế thụ thể IL-2, chiếm 64,7%. Thuốc UCMD duy trì chủ yếu với tacrolimus (94,1%). Tỷ lệ sống còn thận ghép tại thời điểm 1-năm, 3-năm, và 5-năm tuần tự là 100%, 97,7%, và 95,1%. Tỷ lệ sống còn BN nhận thận tại các thời điểm tuần tự là 96,1%, 93,6%, và 93,6%. Các yếu tố ảnh hưởng đáng kể đến tỷ lệ sống còn thận ghép bao gồm: tuổi NHT trên 60 tuổi, KDPI trên 80%, trì hoãn chức năng thận ghép, thải ghép cấp trong năm đầu, và độ lọc cầu thận ước tính thấp hơn 45 ml/phút/m2 da tại thời điểm tháng sau ghép. Các yếu tố ảnh hưởng đáng kể lên tỷ lệ sống còn BN bao gồm: NHT đủ tiêu chuẩn là NHT chết tuần hoàn, BN nhận thận dưới 40 và 50 tuổi, và trì hoãn chức năng thận ghép. Kết luận: Nghiên cứu cho thấy tỷ lệ sống còn của thận ghép và tỷ lệ sống còn của BN nhận thận tương đồng với các tác giả khác trên thế giới. Cho nên sử dụng thận từ NHT chết là khả thi. Tuy nhiên do số lượng BN trong nghiên cứu còn giới hạn, nên cần tiếp tục nghiên cứu với số lượng BN nhận thận lớn hơn., Tóm tắt tiếng anh, Deceased donors (DD) help expand the organ donation pool and are becoming a global trend in transplantation as the supply from living donors is insufficient to meet the demand. Research Objectives: To present the graft survival rate, patient survival rate, and factors influencing these survival rates. Research Methods: This is a retrospective, descriptive cohort study, which included cases that received kidneys from DDs from April 2008 to December 2021 at Cho Ray Hospital. Results and discussion: The study included 27 DDs with a median age of 37, with males making up 88.8%. The median KDPI (Kidney Donor Profile Index) was 35%. There were 51 kidney recipients, with a median age of 37, 72.5% males, a body mass index of 20.9, a median dialysis duration of 39.3 months, with hemodialysis being the predominant treatment method. The median cold ischemia time was 7 hours and the warm ischemia time was 38 minutes. The main induction immunosuppressant drugs were IL-2 receptor inhibitors, constituting 64.7%, and the main maintenance immunosuppressant was tacrolimus (94.1%). The graft survival rates at 1-year, 3-years, and 5-years were sequentially 100%, 97.7%, and 95.1%. The patient survival rates at these intervals were 96.1%, 93.6%, and 93.6%. Significant factors affecting graft survival included: donor age over 60 KDPI over 80%, delayed graft function, acute rejection in the first year, and estimated glomerular filtration rate lower than 45 ml/min/1.73m2 at one-month post-transplant. Significant factors affecting patient survival were: DD meeting the circulatory death criteria, recipients under 40 and 50 years of age, and delayed graft function. Conclusion: The study indicates that the graft and patient survival rates are comparable to international figures. Thus, using kidneys from DDs is feasible. However, given the limited sample size in the study, further research with a larger number of recipients is recommended.

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