儿童供者单肾移植给成人受者的临床疗效观察

Single kidney transplantation from pediatric donors after citizens death to adult recipients

目的 探讨3～12岁儿童供者单肾移植给成人受者的临床疗效.方法 总结自2013年5月至2017年1月间实施的50例3～12岁儿童供者单肾移植给成人受者的临床资料.供者29例,其中男性17例,女性12例,年龄（6.4±2.5）岁（3～11岁）,体重（19.1±5.9）kg（13～38 kg）;其中“中国一类”2例,“中国二类”23例,“中国三类”4例;供肾纵轴长（7.9±0.8）cm（6～9.5 cm）.50例受者的年龄为（38.5±12.1）岁,体重为（56.1±13.1）kg,男性24例,女性26例.除3例为再次肾移植外,其他受者均为初次肾移植.结果 50例受者术后早期发生移植肾功能延迟恢复15例（30％）,均好转.所有受者的估算肾小球滤过率在术后3个月内快速上升,此后稳定增加,至术后1年时达（82.3±13.4）ml·min-1·1.73m-2,术后2年时达（83.8±22.5）ml· min-1·1.73 m-2.随访期间发生急性排斥反应4例（8％）,3例治疗后好转;肺部感染4例,其中导致死亡2例.平均随访19个月,未删失的移植肾存活率为94％,受者存活率为96％.结论 3岁以上儿童供者单肾移植给成人受者能够取得安全而满意的近期移植效果,在缺乏合适儿童受者的情况下,可缩短成人受者等待肾移植时间,在一定程度缓解供需矛盾.

Objective To investigate the feasibility and safety of the single kidney transplantation from pediatric donors to adult recipients.Methods From May 2013 to January 2017,a total of 50 single kidney transplants from pediatric donation after citizen death （DCD） donors of age between 3 to 12 years to adult recipients were performed and the data were summarized.Results The average age of donors was 6.4 ± 2.5 years with an average donor weight of 19.1 ± 5.9 kg,and the average kidney length was 6.3 ± 0.6 cm.For the 50 adult recipients,the average age was 38.5 ± 12.1 years,the average body weight was 56.1 ± 13.1 kg,and the number of female patients was 26 （52%）.All except 3 of these patients were transplanted for the first time.Delayed graft function （DGF） was observed in 15 patients （30%）.The average value of eGFR among all the patients was rapidly increased in the first 3 months after transplantation and then steadily increased to （82.3 ± 13.4） mL· min-1·1.73 m-2 at 1 st year,followed by （83.8 ± 22.5） mL· min-1·1.73 m-2 at 2nd year.Four renal grafts developed acute rejection （8%）,and 3 of them were successfully reversed by the treatment.Pulmonary infection occurred in 4 recipients,and 2 died.During a follow-up period of 19 months,uncensored grafts survival was 94%,and patients survival was 96%.Conclusion Excellent intermediate-term transplant outcome can be achieved by using single kidneys from pediatric donors elder than 3 years,which may shorten the waiting time in adult recipients and alleviate the contradictions in the absence of suitable pediatric recipients.