比较扩大标准供者(ECD)与同期标准供者(SCD)供肾移植临床资料，观察ECD供肾移植中长期疗效。

回顾性分析2008年1月至2018年6月期间解放军第九二三医院实施的公民逝世后器官捐献肾移植供受者临床资料。根据供者是否符合ECD标准将对应受者分为ECD组(n＝223)和SCD组(n＝198)。观察起点为移植手术当天，观察终点为移植肾失功，包括恢复透析、再次移植或死亡，且不排除非免疫因素引起的移植肾丢失或非移植肾功能衰竭导致的死亡。采用Wilcoxon符号秩和检验比较非正态分布计量资料，采用χ²检验比较计数资料。采用Kaplan-Meier法绘制生存曲线，计算中位生存时间并采用log-rank检验进行比较。P<0.05为差异有统计学意义。

随访至2021年6月，ECD组和SCD组受者术后AR发生率分别为21.5%(48/223)、19.7%(39/198)，差异无统计学意义(χ²＝0.214，P>0.05)；术后1年内AR发生率分别为18.4%(41/223)和7.6%(15/198)，差异有统计学意义(χ²＝10.627，P<0.05)。ECD组和SCD组受者肺部感染发生率分别为43.5%(97/223)和33.3%(66/198)，差异有统计学意义(χ²＝4.567，P<0.05)，术后6个月内肺部感染发生率分别为30.9%(69/223)和22.7%(45/198)，差异无统计学意义(χ²＝3.584，P>0.05)。ECD组和SCD组受者死亡率分别为9.9%(22/223)、8.6%(17/198)，差异无统计学意义(χ²＝0.1929，P>0.05)。ECD组和SCD组受者移植肾失功发生率分别为11.7%(26/223)、5.1%(10/198)，差异有统计学意义(χ²＝5.858，P<0.05)。ECD组和SCD组受者/移植肾中位生存时间分别为120、146个月，差异有统计学意义(χ²＝4.352，P<0.05)。ECD组和SCD组受者随访过程血清肌酐最低值中位数分别为120 μmol/L(48~591 μmol/L)、95 μmol/L(42~630 μmol/L)，差异有统计学意义(Z＝-5.967，P<0.05)。

通过充分评估、慎重取舍并采取个体化治疗方案，ECD供肾移植受者有望获得更理想的中长期预后。

To compare the clinical data of expanded criteria donor (ECD) and standard criteria donor (SCD) kidney transplantation in the same period, and to observe the medium- and long-term curative effect of ECD renal transplantation.

The clinical data of the kidney donors and corresponding recipients from donation after citizen′s death in the 923 Hospital of PLA from January 2008 to June 2018 were retrospectively analyzed. According to whether the donor met the criteria of ECD, the corresponding recipients are divided into ECD group (n=223) and SCD group (n=198). The starting point of observation was the day of transplantation, and the end point of observation was kidney failure, including return to dialysis, retransplantation or death, and the loss of transplant kidney caused by non-immune factors or death which was not caused by transplant kidney failure were not excluded. Wilcoxon signed rank sum test was used to compare non-normal distribution measurement data, and chi-square test was used to compare count data. Kaplan-Meier method was used to draw the survival curve, and the median survival time was calculated and compared by log-rank test. P<0.05 indicated that the difference was statistically significant.

Up to June 2021, the incidence of postoperative acute rejection (AR) in the ECD group and the SCD group was 21.5% (48/223) and 19.7% (39/198), respectively (χ²=0.214, P>0.05). The incidence of AR within 1 year after transplantation was 18.4% (41/223) and 7.6% (15/198), respectively (χ²=10.627, P<0.05). The incidence of pulmonary infection in the ECD group and the SCD group was 43.5% (97/223) and 33.3% (66/198), respectively (χ²=4.567, P<0.05). The incidence of pulmonary infection within 6 months after transplantation was 30.9% (69/223) and 22.7% (45/198), respectively (χ²=3.584, P>0.05). The mortality rates of the ECD group and the SCD group were 9.9% (22/223) and 8.6% (17/198), respectively (χ²=0.1929, P>0.05). The incidence of graft failure in the ECD group and the SCD group was 11.7% (26/223) and 5.1% (10/198), respectively (χ²=5.858, P<0.05). The median renal survival time in the ECD group and the SCD group was 120 and 146 months, respectively (χ²=4.352, P<0.05). The medians of serum creatinine minimum values in the ECD group and the SCD group during follow-up were 120 μmol/L (48-591 μmol/L) and 95 μmol/L (42-630 μmol/L), respectively (Z=-5.967, P<0.05).

It is expected to obtain a better medium- and long-term prognosis in the ECD kidney transplantation through full evaluation, careful choice and individualized treatment.