结合心脏死亡器官捐献(DCD)肾移植受者术后随访情况，探讨供肾热缺血因素对移植肾功能的影响。

回顾性分析2011年5月至2015年6月浙江大学医学院附属第一医院肾脏病中心施行的肾移植术供、受者临床资料。移植术后1年根据受者估算肾小球滤过率(eGFR)≥60 mL·min^－1·(1.73 m²)^－1和<60 mL·min^－1·(1.73 m²)^－1将受者分为高肾功能组与低肾功能组，最终纳入340例受者，其中高肾功能组259例，低肾功能组81例。根据DCD供者手术记录表，整理分析两组供者不同收缩压(SBP)及血氧饱和度(SpO₂)热缺血时间段。符合正态分布计量资料以均数±标准差(±s)表示，采用t检验比较高、低肾功能组供、受者一般资料、供者不同SBP和SpO₂热缺血时间段差异；采用Wilcoxon符号秩和检验比较两组受者供肾获取时肾小球和肾小管病理评分。计数资料以百分数表示，采用卡方检验比较两组供、受者性别和移植肾功能延迟恢复(DGF)发生率。P<0.05为差异有统计学意义。

截至2016年6月，所有受者随访(28.4±2.8)个月(13.1～62.5个月)。术后1年内高、低肾功能组DGF发生率分别为14.7%(38/259)、22.2%(18/81)，差异无统计学意义(χ²＝2.557，P>0.05)。高肾功能组平均年龄和BMI均低于低肾功能组，男性比例和捐献时eGFR高于低肾功能组，差异均有统计学意义(t＝－6.363、－2.049、4.190, χ²＝4.863，P均<0.05)；高肾功能组供肾获取时肾小球病理评分低于低肾功能组，差异有统计学意义(Z＝－2.606，P<0.05)。高肾功能组受者年龄小于低肾功能组，而男性比例高于低肾功能组，差异均有统计学意义(t＝－2.790, χ²＝9.658，P均<0.05)。高、低肾功能组初始SpO₂降低40%、撤除生命支持至SpO₂测不出以及90%、80%、70%、60%初始SpO₂至SpO₂测不出的平均时间分别为(5.9±4.3)和(4.8±3.3)、(8.0±5.2)和(6.1±4.4)、(4.5±3.6)和(3.5±2.8)、(4.0±3.7)和(2.9±2.4)、(4.0±3.6)和(2.8±2.7)、(3.6±3.5)和(2.4±2.5) min，差异均有统计学意义(t＝2.088、2.983、2.328、2.622、2.557、2.759，P均<0.05)。高、低肾功能组初始SpO₂降低10%、40%、撤除生命支持至SpO₂测不出、60%初始SpO₂至SpO₂测不出平均变化速率分别为(2.40±1.78)和(2.90±1.70)、(8.71±6.96)和(15.01±12.97)、(19.60±17.49)和(25.80±22.85)、(22.41±15.94)和(29.93±19.36) %/min，差异均有统计学意义(t＝－2.230、－5.647、－2.577、－3.514，P均<0.05)。

DCD肾移植预后受供、受者年龄、BMI等一般因素影响。供者高、低SpO₂时间段长短及变化速率与移植肾功能相关，DCD供肾移植过程中可通过优化手术流程等方法缩短低SpO₂时期时间，以减少供肾热缺血损伤，改善受者预后。

The effect of renal ischemia-reperfusion injury on the function of renal allograft was investigated after donation after cardiac death (DCD) renal transplantion.

We retrospectively analyzed the clinical data of renal transplant donors and recipients at the Kidney Disease Center of the First Affiliated Hospital of Zhejiang University from May 2011 to June 2015. One year after transplantation, the recipients were classified into high renal function group [estimated glomerular filtration rate (eGFR) ] ≥60 mL·min^-1·(1.73 m²)^-1) and low renal function group (eGFR <60 mL·min^-1·(1.73 m²)^-1. According to the DCD donor surgery record, the systolic blood pressure (SBP) and blood oxygen saturation (SpO₂) of the donors during different periods of warm ischemia in two groups were analyzed. The normal distribution measurement data were showed as the mean±standard deviation (±s), and the t-test was used to compare the basic characteristic data, donor SBP and SpO₂ in the different warm ischemia periods between the two groups, except for gender. The Wilcoxon Signed Rank test was used to compare the pathological scores of glomerular and glomerular of donor kidneys between two groups when organ procurement. Count data were expressed as a percentage. Chi-square test was used to compare the donor gender and DGF incidence in the two groups. P<0.05 was considered statistically significant.

By June 2016, all patients were followed up (28.4±2.8) months, ranged from 13.1 to 62.5 months. 340 recipients were eventually included, including 259 recipients in the high renal function group and 81 recipients in the low renal function group. The incidence of DGF was 14.7% (38/259) and 22.2% (18/81) in high and low renal function groups within 1 year after transplantation, with no significant difference (χ²=2.557, P>0.05). The average age and BMI of donors in the high renal function group were lower than those in the low renal function group, and the percentage of males and eGFR at the time of donation was higher than that in the low renal function group (t=-6.363, -2.049, 4.190, χ²=4.863, P all <0.05). The renal pathology scores of donors with high renal function were lower than those with low renal function, and the difference was statistically significant (Z=-2.606, P<0.05). The recipients of the high renal function group were younger than the low renal function group, and the proportion of males was higher than the low renal function group, with significant difference (t=-2.790, χ²=9.658, P<0.05). In the high and low renal function groups, the initial SpO₂ decreased by 40%, the average time from life support device withdrawal, different initial SpO₂ with 90%, 80%, 70%, 60% of to SpO₂ to SpO₂ could not be measured, were (5.9±4.3) and (4.8±3.3), (8.0±5.2) and (6.1±4.4), (4.5±3.6) and (3.5±2.8), (4.0±3.7) and (2.9±2.4), (4.0±3.6) and (2.8±2.7), (3.6±3.5) and (2.4±2.5) minutes, with significant difference (t=2.088, 2.983, 2.328, 2.622, 2.557, 2.759, all P<0.05). In the high and low renal function groups, the average change rate of initial SpO₂ declined by 10%, 40%, life support device withdrawal to SpO₂ not detected, initial 60% SpO₂ to SpO₂ not detected were (2.40±1.78) and (2.90±1.70), (8.71±6.96) and (15.01±12.97), (19.60±17.49) and (25.80±22.85), (22.41±15.94) and (29.93±19.36) percentage per minute, with significant difference (t=-2.230, -5.647, -2.577, -3.514, P all <0.05).

The prognosis of DCD renal transplantation was influenced by the general factors such as donor and recipient age and BMI. The high and low renal function recipients had different high and low SpO₂ time intervals and different rates of change derived from the DCD donors. During DCD renal transplantation, optimized surgical procedures should be taken to minimize the low SpO₂ duration, so that the warm ischemia damage of the donor would be alleviated to acheive a better prognosis of tranplant.