儿童肾移植的远期预后

The long-term results of pediatric kidney transplantation

目的 探讨儿童肾移植的长期存活情况及其对生长发育、就业、婚育的影响。方法 以27例肾移植5年以上的儿童受者为研究对象作回顾性分析。结果 本组受者术后1、3、5、10年人存活率分别为100％、92．6％、85．8％、68．6％，1、3、5、10年。肾存活率分别为96．3％、89．2％、82．6％、66．1％，均采用以环孢素A或他克莫司为基础的二联或三联免疫抑制方案，移植后第1年体重增加4～10kg，女性增高0～2cm，男性增高2～5cm。术后接受初中以上教育者占44．4％。现存活的20例受者年龄20-39岁，男性就业率46．2％（6／13），女性57．2％（5／7），已婚12例（60％），男性生育5例，女性生育3例，子女均健康，服药不依从比例占30％，主要并发症包括高血压（40％）、高血脂（30％）、牙龈增生（30％）、多毛（25％）、肝功能损害（20％）、单纯疱疹（15％）、糖尿病（5％）、白内障（5％）。死亡7例，死亡年龄21～39岁，分别死于感染（28．6％）、肝功能损害（28．6％）、心衰（42．8％）。结论 肾移植是终末期。肾功能衰竭儿童的最佳治疗方法。应重视受者的不依从行为，合理使用免疫抑制剂。呼吁社会各界对移植受者给予就业等多方面的支持。

Objective To explore the long term results of pediatric kidney transplantation and the effect of renal allograft on the growth, development, employment, marriage and breed. Methods Twenty seven children with end-stage renal disease （ESRD） received the renal allograft five years ago. The survival rates of patient and kidney, renal function, stature, and employment were analyzed retrospectively. Results The 1-, 3-, 5- , 10- year graft survival rates were 96. 3%, 89. 2%, 82.6%and 66. 1%, respectively, and the corresponding patient survival rates were 100%, 92. 6%, 85.8% and 68. 6%. The maintenance immunosuppressive protocol for all 27 patients included cyelosporine combined with predriisolone （2 cases）, or cyclosporine combined with azathioprine （5 cases）, mycophenolate mofetil （12 cases）, and tacrolimus combined with mycophenolate mofetil （8 cases）. The body weight was increased 4 to 10 kg and the body height was increased 0 to 2 cm in girls and 2 to 5cm in boys during the first year post-transplantation. Thirteen （44. 4%） recipients continued to accomplish their education above junior high school. The employment rate was 46. 2% in boys, and 57. 2% in girls. Twelve patients were married, and 5 male and 3 female patients had healthy children. Noncom pliance was in 30% of the recipients. The main complications included hypertension （40%）, hyperlipidemia （30%）, gingival hyperplasia （30%）, crinosity （25%）, impaired liver function （20%）, simple herpes zoster （15%）, diabetes mellitus （5%） and cataract （5%）. Seven patients died at the age ranged from 21 to 39 years. The causes of death were infection （n = 2）, impaired liver function （n = 2） and heart failure （n = 3）. Conclusions The satisfactory long-term results can be gained after rational use immunosuppressive agents in children with renal transplantation.