总结经心肺复苏中国Ⅲ类心脏死亡器官捐献(DCD)供肾移植经验。

回顾性分析2013年1月至2015年12月解放军第三〇三医院施行的中国Ⅲ类DCD供肾移植的供、受者临床资料。根据供肾是否来源于经心肺复苏供者，将受者分为心肺复苏组和对照组。共纳入304例受者，其中心肺复苏组76例(对应供者48例)，对照组228例(对应供者143例)。两组供者体外膜肺氧合(ECMO)和供肾Lifeport使用比例、受者术后3个月群体反应性抗体(PRA)阳性比例、移植肾功能延迟恢复(DGF)和急性排斥反应(AR)发生比例比较采用卡方检验；两组供者供器官获取前血清肌酐、受者术后血清肌酐降至442 μmol/L时间比较采用Wilcoxon检验；两组供肾冷、热缺血时间、受者年龄和术后3个月血清肌酐比较采用t检验。P<0.05为差异有统计学意义。

两组供、受者ABO血型均相符。心肺复苏组HLA配型：5个错配4例、4个错配23例、3个错配39例、2个错配10例。对照组HLA配型：5个错配17例、4个错配89例、3个错配104例、2个错配16例、1个错配2例。心肺复苏组和对照组供者供器官获取前血清肌酐分别为184 mmol/L(30～353 mmol/L)和88 mmol/L(25～407 mmol/L)，差异有统计学意义(U＝－2.760，P<0.05)。两组供者ECMO和供肾Lifeport使用比例、供器官获取前供者血清肌酐、供肾冷/热缺血时间、受者年龄以及术后3个月血清肌酐、PRA阳性比例、DGF和AR发生比例、术后血清肌酐降至442 μmol/L时间差异均无统计学意义(P均>0.05)。

经心肺复苏中国Ⅲ类DCD供者采取适当的维护措施，其供肾移植术后短期内可获得与未经心肺复苏供肾类似效果，Lifeport使用可能在此过程中起重要作用。

To summarize the experience of renal transplantation that donor kidneys from C-Ⅲdonation after cardiac death (DCD) with history of cardiopulmonary resuscitation.

The clinical data of donors of C-Ⅲ DCD and corresponding recipients of renal transplantation in the 303th Hospital of PLA from January 2013 to December 2015 was retrospectively summarized. Recipients were divided into two groups according to history of cardiopulmonary resuscitation of donor kidneys (cardiopulmonary resuscitation group and control group). A total of 304 recipients were selected for the study, there were 76 cases in cardiopulmonary resuscitation group (48 cases of donors) and 228 cases in control group (143 cases of donors). The χ² test was used to compare the usage rate of extracorporeal membrane oxygenation (ECMO) and Lifeport, proportion of panel reactive antibody (PRA) of recipients 3 months after operation, incidence rate of delayed graft function (DGF) and acute rejection (AR) between the two groups; the Wilcoxon test was used to compare serum creatinine of donors before donor organ procurement and time consuming for serum creatinine felling to 442 umol/L of recipients between the two groups; the t test was used to compare cold and warm ischemia time of donor kidneys, age of recipients, serum creatinine of recipients 3 months after operation between the two groups. Statistical significance was approved when P<0.05.

The donors and the recipients were matched in same ABO blood groups typing. HLA typing in cardiopulmonary resuscitation group: 5 locuses mismatch (4 cases), 4 locuses mismatch (23 cases), 3 locuses mismatch (39 cases), 2 locuses mismatch (10 cases). HLA typing in control group: 5 locuses mismatch (17 cases), 4 locuses mismatch (89 cases), 3 locuses mismatch (104 cases), 2 locuses mismatch (16 cases), 1 locuses mismatch (2 cases). The serum creatinine of donors before donor organ procurement between cardiopulmonary resuscitation group and control group were 184 mol/L (30-353 mmol/L) and 88 mol/L (25-407 mmol/L), the difference was statically significant (U=-2.760, P<0.05). No significant difference was found between the two groups in other indexes which were mentioned above (P all>0.05).

The curative effect of renal transplantation that donor kidneys from C-Ⅲ donation after DCD with history of cardiopulmonary resuscitation is similar with those without history of cardiopulmonary resuscitation baseing on active and appropriate measures taken to donors. Lifeport may play a important role in the process.