心脏死亡供者供肾儿童肾移植一例

Pediatric renal transplantation using donation after cardiac death： 1 case report

目的探讨心脏死亡供者供肾儿童肾移植的临床效果。方法供者为男性，年龄49岁，属“中国心脏死亡器官捐献分类标准”中的中国三类；受者为男性，14岁，原发病为肾病综合征、慢性肾功能衰竭。取供者右侧肾脏作为供肾，供肾动、静脉分别与受者髂总动脉、静脉行端侧吻合，移植肾输尿管内置带线双J管后与受者膀胱行隧道式包埋手术，将移植肾放置于受者右侧髂窝上方腹膜后腔。供。肾热缺血时间为12min，冷缺血时间为2h。使用巴利昔单抗和甲泼尼龙行免疫诱导治疗，术后采用他克莫司＋吗替麦考酚酯＋甲泼尼龙的三联免疫抑制方案。结果术后1d时，受者出现ALT急剧升高，诊断为急性药物性肝损害，给予保肝降酶治疗后，ALT降至正常；术后3d时，受者出现腹部肠道不完全梗阻症状，经积极对症处理后症状消失，未发生急性排斥反应及移植肾功能恢复延迟等并发症。术后1个月时，受者顺利出院，至今随访6个月，移植肾功能正常。结论心脏死亡供者供肾儿童肾移植手术安全、有效，但远期效果需要进一步观察。

Objective To evaluate the effect of pediatric renal transplantation using donation after cardiac death （IX;D）. Methods The male DCD meeting Chinese standard Ⅲ （C-Ⅲ） was 49 years old, and the recipient with chronic renal failure was 14 years old. The right kidney of the donor was transplanted to the recipient. The renal artery and renal vein of the donor were end-to-side anastomosed to the common iliac artery and common iliac vein of the recipient, respectively. The graft was transplanted into the fight iliac fosse. Warm ischemia time was 12 rain, and cold ischemia time was 2 h. Immunity induction therapy was performed with basiliximab. Tacrolimus ＋ mycophnolate mofetil ＋ Pred were used as immunosuppressive regimen. Results The transplantation was done successfully. One day after operation, ALT was increased dramatically. The recipient was diagnosed as acute drug-induced liver injury. There was no occurrence of acute rejection and delayed graft function. The recipient was discharged one month after the operation, and followed up for 6 months with normal graft funetioru Conclusion Pediatric renal transplantation using DCD is effective and safe, even though the long-term effect still needs to be further observed.