婴幼儿及学龄前期儿童供肾在儿童肾移植中的应用48例

Transplantation of kidneys from small pediatric donors into pediatric recipients

目的探讨婴幼儿及学龄前期儿童供肾在儿童肾移植中应用的临床效果。方法回顾性分析48例婴幼儿及学龄前期儿童供肾儿童肾移植的临床资料和随访情况。结果根据移植术式的不同分为单肾移植组（36例）和双肾整块移植组（12例）。单。肾移植组受者术后发生血管栓塞1例（2．8％），输尿管梗阻1例（2．8％），原发病复发1例（2．8％），肾功能恢复延迟17例（47．3％）和急性排斥反应4例（11．1％）。双肾整块移植组受者术后发生血管栓塞4例（33．3％），尿漏2例（16．7％），肾功能恢复延迟2例（16．7％），急性排斥反应2例（16．7％）。单肾移植组术后随访3～31个月，受者和移植肾存活率分别为100％（36／36）和94．4％（34／36），末次随访时血肌酐为（68．4±22．1）μmol／L；双肾整块移植组术后随访4～44个月，受者和移植肾存活率分别为100％（12／12）和75％（9／12），末次随访时血肌酐为（55．8±16．7）μmol／L。结论婴幼儿及学龄前期儿童供肾在儿童肾移植中的应用有利于缓解移植器官短缺的问题。术前选择合适的供、受者，术中注意手术操作，术后加强管理和并发症的处理，婴幼儿供肾在儿童肾移植中的应用可获得较好的效果。

Objective To investigate the clinical features of kidney transplantation of small pedi atric donors to pediatric recipients. Method A retrospective analysis of 48 kidney transplants from small pediatric donors into pediatric recipients was performed. Result Based on the transplantation types, the patients were divided into two groups： the single kidney transplantation （SKT） group and the en bloc kidney transplantation （EBKT） group. SKT was performed on 36 patients and EBKT on 12 patients. In the SKT group, postoperative complications included vascular thrombosis in 1 case （2. 8%）, primary disease recurrence in 1 case （2. 8%）, ureteral stenosis in 1 case （2. 8%）, delayed graft function in 17 cases （47. 3 %） and acute rejection in 4 cases （11.1 G）. In the EBKT group, postoperative complications included vascular thrombosis in 4 cases （33.3%）, urine leak in 2 cases （16. 7%）, delayed graft function in 2 cases （16. 7%） and acute rejection in 2 cases （16. 7%）. At last follow-up, patient survivals were 100% in both groups, whereas graft survival was 94. 4% （34/36） in the SKT group and 75% （9/12） in the EBKT group. The mean serum creatinine in the SKT and EBKT group was （68. 4 ±22. 1 ） and （55.8 ±16. 7） μmol/L, respectively. Concision Favorable outcomes can be obtained from transplantation from small pediatric donors. The use of this donor popula tion for pediatric recipients should be encouraged.