婴幼儿心死亡后捐献肾行肾移植术:2例病例报告并文献复习(英文)

Transplantation of en bloc kidneys from cardiac deceased small pediatric donors: 2 case reports and literature review

目的:加深针对扩大标准供肾的心脏死亡器官捐献(donation at er cardiac death,DCD)肾移植手术术中、术后管理的认识。方法:2例供肾来自于诊断为脑死亡的2例低龄儿童供者,年龄分别为11个月和1岁7个月,脑死亡的原因分别是重症婴儿肝综合征和重症颅脑外伤。2例供者出现心死亡后,切取双肾整块,并分别整块移植给了2位受者。2例受者的年龄分别是37岁和41岁。结果:术后随访6个月,2例受者移植肾功能基本正常。2例受者术后都出现大量血性引流液,在给予相应治疗后停止,未出现急性排斥反应和其他手术并发症。结论:采用改进的技术可以安全采用年龄<3岁的婴幼儿DCD供肾;手术后短期效果满意,有助于扩大供体池,但血管并发症值得重视。

Objective: To gain an insight into the transplantation with donor kidneys from extended criterion donation after cardiac death(DCD) and to improve the management during and after renal transplantation Methods: Renal transplantation in 2 patients who used organs from small pediatric donors(<3 years) was performed. The graft kidneys were procured from 1 donor aged 11 months and the other 1 year and 7 months. h e 2 donors were diagnosed as brain death caused by serious infantile hepatitis syndrome and severe craniocerebral injury, respectively. At er the cardiac death, en bloc organ resection was performed. En bloc kidneys were transplanted to 2 adult recipients who were 37 and 41 years old, respectively. Results: The recipients were followed-up for 6 months. Both of them developed large volume of bloody drainage in the early post-operational period and relieved at er relevant treatment. h e kidney grafts functioned well and no other surgical complications or acute rejections happened during the follow-up. Conclusion: Based on modified peri-operative techniques, it is safe to perform renal transplantation with kidneys procured from cardiac death donors who are younger than 3 years old, an important source to increase the number of organs available for transplantation, yet the vascular complications requir at ention.