23例儿童肾移植临床分析

Clinical study of pediatric renal transplantation: a report of 23 cases

目的探讨儿童肾移植的临床特点,提高肾移植效果。方法对23例3～17岁的儿童肾移植资料进行回顾性分析。结果术后随访5d至72个月,平均26.1个月,死亡1例,人、肾1年存活率分别为93.3%和86.6%。术后7例发生急性排斥反应,6例治疗后逆转,1例因并发移植肾静脉栓塞,切除移植肾;2例发生慢性排斥反应,1例移植肾功能丧失,恢复血液透析,另一例仍在随访治疗中;其它并发症有肺部感染4例,心力衰竭2例,肾静脉阻塞2例,肝功能损害2例,急性肾小管坏死1例。结论儿童肾移植具有一定的特殊性,其血管较细、急性排斥反应发生率较高以及药物代谢快等都是应妥善处理的问题。

Objective To investigate the clinical features of pediatric renal transplantation and improve the effect of pediatric renal transplantation. Methods Clinical data of 23 children (3 17 years old) who underwent renal transplantation were retrospectively analyzed. Results In these 23 recipients, 4 cases suffered from pulmonary infection, 2 from heart failure and 2 from transplanted renal vein echmasis. Two patients' liver function was injured and one suffered from acute tubular necrosis. The incidence of acute rejection (AR) was 30.4 % (7/23) and that of chronic rejection (CR) was 8.7 % (2/23). During the follow up of 5 days to 72 months (average of 26.1 months), one died of heart failure and severe pulmonary infection. The 1 year patient and graft survival rate was respectively 93.3 % and 86.6 % . Conclusion Different from renal transplantation in adult, pediatric renal transplantation has special treatment in the operation process. HLA well matching is necessary for a good effect of pediatric renal transplantation. In spite of its high AR incidence, pediatric renal transplantation is an effective treatment with its satisfactory one year graft survival rate. Nevertheless, its long term effect should be improved much more.