Thông báo về kết qủa của một số trường hợp ghép thận từ người cho chết não

THONG BAO VE KET QUA CUA MOT SO TRU&NG HOP GHEP THAN TUf NGimi CHO CHET NAO

HA PHAN HAI AN, TRAN MINH TUAN, NGUYEN MANH TUONG,

NGUYI N TH! THUY, DONG VAN HE, NGUYI N TIEN QUYET

Benh vien Hiru nghj Viet Dire, Hi Ngi

TOM TAT.

Hang nam so lirgng bpnh nhin suy thpn giai doan

cuoi cin dtrgc dieu tri thay thi tang dan. Mgt giai phap

hipu qua doi v&l tinh huong nay la ghep thpn. Tuy nhien,

ngw&i hien than hipn nay rit hiem va chit yeu dya vao

nguon cho song. Con so nguoi tir vong do chin thtrang

sg nao & Vipt nam rat cao nhung so nguoi cd thi hiin

tpng dtrgc lpi rat hpn chi do mgt s6 quan nipm hpp hdi

ciia ngtr&l dan trong cgng dong. Trong khi dd, kit qua

ghep thpn tir nguoi cho chit nao hoac ngimg tim cua

cac tmng tim tren thi gl&i lpi rat hda hpn. Chiing tdi tiin

hanh ghep than tir ngtr&l cho chit nao cho 6 bpnh nhin

suy than gial dopn cuoi tpi bpnh vipn Hiru nghj Viet Dire

thing 5/2010. Ba trong tong so 6 bpnh nhan khdng hda

hgp HLA. Tit ca eae bpnh nhin deu khdng cd bien

chimg lien quan din phau thupt. Kit qua theo ddi trong

vdng 6 thing sau ghep cho thay tinh trpng chirc nang

than va ehire nang tpo miu duoc cai thipn rd rpt va duy

tri on dinh trong gi&i hpn binh thw&ng. Thuoc ire chi

miin djch duy tn bao gom Prednisolon, Tacrolimus va

Mycophenolate mofetil. Th&i gian nim vipn tmng binh li

10 ngay.

Kit lupn: v&i kit qua btr&c dau rat ding khich lp,

chiing ta cin thiic day vipc hien md tpng tw ngir&i cho

chet nao di gial quyet hipu qua tinh trpng suy cic tpng

glal dopn cuoi, trong dd ed suy thpn giai dopn cuoi.

Tir khda: suy thpn giai dopn cuoi, ghep thpn, nguoi

cho chit nao

SUMMARY:

Recently the number of end stage mnal disease

requiring replacement therapy is Increasing. Kidney

transplantation Is one of cost-effective modalities of

replacement therapy but the number of kidney donors is

very limited and mainly originated from living donation. In

Vietnam there is high mortality rate due to head injury

but organ donation is widely unaccepted by many of

Vietnameses. The results of kidney transplantation fmm

deceased donors in different centers in the worid are

promising.

We pedonved kidney transplantation for 6 ESRD

patients from brain-dead donors at Viet Due University

hospital in May 2010. Three of 6 patients had no HLA

match. All 6 patients did not have peri- and

postoperative complications. After 6 months, their kidney

function and hematopoietic function have recovered and

stabilized within normal ranges. The maintenance

Immunosuppressive mglmen at discharge mainly

included Prednisolone, Tacmllmus and Mycophenolate

mofetil. The median hospitalization was 10 days.

Seeing the encouraging preliminary results the

promotion for brain-dead or deceased donation should

be conducted in order to effectively manage the patients

with end stage diseases including kidney disease.

Key words: end stage renal disease, kidney

transplantation,brain-dead donor

DAT VAN Dfe

Hien nay, sd benh nhan suy than giai doan cudi ngdy

cdng cd xu hu'dng tang cao. Theo sd lieu thdng ke cua

USRDS (CO quan thdng ke eae benh ly thgn ciia Hoa ky),

sd ngudi My mde benh than mgn tinh trong giai doan

2003-2006 chilm 14,2% dan sd d dp tudi ttr 20 trd len [1]

Tan suat hien mde eua benh than giai dogn eudi cung

tdng rat ddng k l trong vdng 1 thdp nien vtra qua. Nam

1998, sd lu'png bpnh nhan suy than giai doan cudi can

dilu tri d Hoa ky chilm 0,95% sd benh nhan chung, trong

khi ehi phi de dilu trj cho nhdm benh nhan ndy chiem tdi

6,9% ngdn quy y te, tuong duong 150 ty USD; cho tdi

ndm 2008, sd lu'png benh nhdn suy than giai dogn cudi

da tdng len tdi 1,3% tdng sd bpnh nhdn, vdi tdn suat hipn

mac Id 1698/1 tripu dan, vd chi phi dilu trj tdng len,

chiem 7,9% ngdn sdch y te, tuong duong 273,8 ty USD

[1]. Ddy la mpt gdnh ndng dang k l cho gia dinh va xa hpi.

Nhieu qudc gia khdc tren thi gidi cd tdn suat hien mde

bpnh thdn mgn tinh va suy than giai dogn cudi rat cao, vdi

sd ngudi can dirpc dilu tri duy tri vd chi phi dilu tri rat Idn.

Trong khu vyc chdu A, tgi Dai loan va Nhat ban, ed tdi

hon 2000 ngirdi bj benh thgn giai doan cudi/1 tripu dan,

trong khi tgi Phillipin con sd nay Id khoang hon 100 ngudi.

Cy Vipt nam hipn chua cd thdng ke ddy dii, nhirng theo

udc tinh ciia Bp Y t l Vipt Nam, cd khoang 260 ngudi bj

bpnh thgn giai dogn cudi/1 tripu ddn. [2]

Vipc dieu trj eho bpnh nhdn suy thgn giai dogn cudi

bao gdm 3 phirong thirc chinh: chgy thgn nhan tgo, Ipc

mdng byng vd ghep thgn. Tgi nhilu qudc gia tren thi

gidi thgn nhdn tgo la Phu'Ong phdp dieu trj phd biln nhat.

Vipc chgy thgn nhdn tgo duy tri cupc sdng Id gdnh ndng

cho ngdn sdch ciia cpng ddng va cung Id mpt ylu td gdy

dp lye rat Idn ddi vdi cupc sdng ciia tirng bpnh nhdn, do

phirong phdp dilu tri nay cd mpt sd mgt han chi v l chat

lupng mgc du da cd rat nhieu tien bp ve ky thugt dupc

dp dyng. Lpc mdng byng cung la mpt Phu'Ong phdp dieu

tri than suy giai doan cudi vdi nhieu iru diem, nhat la cho

nhO'ng benh nhdn cao tudi vd ed chire ndng tim mgch

khdng dn dinh. Ngirpc Igi, phirong phdp nay khd thyc

hipn dupc d nhtrng noi mdi trirdng vp sinh va y thirc ty

giac cua ngudi dan chira cao. Ddi vdi nhO'ng ngudi mac

mot sd bpnh khiln eho vipc ty phyc vu ban than trd

thdnh khd khan, nhu Parkinson, giam hodc mat thi

lyc,... phuong phdp ndy khdng thyc hipn dirpe.

Ghep than la Phu'Ong thu'c dilu trj hipu qua va mang Igi

chat lu'png cupc sdng toi u'u cho bpnh nhdn suy thgn giai

dogn eudi. Sgu khi bpnh nhdn du'pc ghep than on dinh, tu￾ndm thir 3 trd di, ehi phi dl dieu trj duy tri cho bpnh nhan

ghep thgn se gigm xudng thap hon so vdi ehi phi chgy thgn

nhdn tgo. Tuy nhien dl cd thi ghep thgn dupc, dilu quan

trpng bgc nhat Id phai ed ngydi hiin thgn.

Tgi Vipt Ngm, tinh din 2009, ca nu'dc ed khoang tren

11000 bpnh nhdn suy thgn giai dogn cudi dang dupc

dilu tri thay the thdn, chii ylu la bdng phuong phap

chgy thgn nhdn tgo (khoang 80% tdng so) Mgc dii

chu'ong trinh ghep than da dupc bit dau tu' ndm 1992,

Y HOC THirc HANH (755) - SO 3/2011 47