儿童肾移植47例报告

A clinical study of pediatric renal transplantation： a report of 47 cases

目的探讨儿童肾移植围手术期处理及免疫抑制方案。方法回顾性分析2008年12月至2015年9月47例儿童肾移植受者相应供者的临床资料，记录肾移植术后不同时间点血肌酐、移植肾长径、免疫抑制剂浓度、不良事件及受者和移植肾存活率。结果47例儿童受者中，接受亲属活体供肾、成人器官捐献供肾和儿童器官捐献供肾的受者分别为3例、2例和42例。受者随访时间为（18．6±17．3）个月（10d至82个月），术后血肌酐均下降良好。3例发生急性排斥反应，治疗后均逆转；1例术后6个月出现移植肾血管狭窄，介入下行移植肾动脉扩张术，术后肾功能逐渐恢复至正常；1例原发性高草酸尿症患者术后1年逐渐出现血肌酐升高，经保守治疗后血肌酐维持在220～270μmol／L；3例发生慢性排斥反应，5例出现药物性肝功能损害，3例发生骨髓抑制。儿童供肾受者和成人供肾受者术后1年蛋白尿发生率分别为21．4％和20％（P〉0．05）；2例分别于术后2周和15个月死于重症肺部感染。1年受者和移植肾存活率分别为97．9％和97．9％，2年受者和移植肾存活率分别为95．8％和95．8％。结论儿童肾移值术后外科并发症发生率高，围手术期管理复杂，因此避免继发感染和外科并发症是移植成功的关键。

Objective To investigate the perioperative management and therapeutic regimen of immunosuppressant in pediatric renal transplantation. Method From December 2008 to September 2015, the clinical data of 47 pediatric patients and 27 donors were retrospectively analyzed to observe the rate of acute rejection, delayed graft function, postoperative complications and patient and graft survival rate. Result In these 47 recipients, there were 3 cases from living relative donors, 2 cases from adult donors and 42 cases from pediatric donors. Six cases suffered delayed graft function. The renal function of 5 of them got back to be normal through regular dialysis after 2 - 4 weeks and one case died of pulmonary infection. And 3 episodes of acute rejection were diagnosed. Four cases suffered drug-induced liver damage and one suffered transplant renal vascular stenosis. Three cases suffered bone marrow depression. Serum creatinine of one case who suffered primary high oxalate urinary disease gradually increased and was maintained at 220 - 270 mol/L after treatment. The incidence of proteinuria of recipients from pediatric donors and adult donors respectively was 21.4% and 20%, and there was no significant difference between the two groups （P〉0. 05）. Two cases died of pulmonary infection. During the follow-up period of 10 days to 82 months, the one-year patient and graft survival rate was respectively 97. 9%/97. 9% and two-year patient and graft survival rate was respectively 95.8%/95. 8%. Conclusion Pediatric renal transplantation is complex and has a high incidence of surgical complications. Perioperative management should be enhanced, and infection and renal vascular complications should also be avoided.