儿童肾移植的临床特点(附22例报告)

The Clinic Characteristic Analysis With Pediatric Renal Transplantation

目的:探讨儿童肾脏移植的手术、围手术期处理及免疫移植剂应用的特点。方法:对我院22 例儿童尿毒症患者行肾移植术,尸体肾移植21例,活体亲属供肾的肾移植1例。供肾动脉与受者的髂总动脉吻合 8 例,供肾动脉与受者的髂外动脉吻合3例,供肾动脉与受者的髂内动脉吻合 11 例。免疫抑制剂方案:7 例为 CsA加Aza加Pred;9例为 CsA加 MMF加 Pred;6 例为 FK506 加 MMF加 Pred。结果:1、3、5 年人/肾存活率分别为96.6%/94.8%,88.2%/81.8%,82.5%/76.3%;急性排斥反应、急性肾小管坏死发生率各为18.1%;术后免疫抑制剂每千克体重剂量较成人显著高。结论:良好的组织配型、成功的手术和正确的围手术期处理,对患者相当重要;加强随访,提高患儿的依从性。

Objective:Assume our experience of the pediatric renal transplantation , compared the characteristic with pediatric and adult in operation, intra-operation treatment and application of immunosuppression.Methods:Between 1992 and 2003, 22 cases patients underwent renal transplantation. According to donor source, living related 1 case, cadaveric related 21 cases. All patients underwent post kidney transplantation extraperitoneally with renal vein anastomosis to external iliac veina cava ;8 cases renal artery anastomosis to distal aorta,3 cases renal artery anastomosis to external iliac aorta,11 cases renal artery anastomosis to internal iliac aorta, Immunosuppression prototal:7 cases wree CsA+Aza+Pred; 9 cases were CsA+MMF+Pred; 6 cases were FK506+MMF+Pred;Results:1.The patient/graft survival rate of one-year 、three-years、five-years were 96.6%/ 94.8%、 88.2%/ 81.8% and 82.5%/ 76.3% respectively; 2.The acute rejection rate was 18.1% and ATN rate was 18.1%; 3.Compared the immunosuppressive dosage,children's dosage(mg/kg.d )was more higher than adult.Conclusions:1.Good mismatch、successful operation and with careful and intense postoperative follow-up to ensure long-term success.2. Children's dosage(mg/kg.d )was more than adult; 3. Regular visit was very important.