儿童单侧供肾成人肾移植的临床疗效

Clinical efficacy and application criteria of single kidney transplantation from pediatric donors

目的分析儿童单侧供肾成人肾移植的临床疗效。方法选取2006年10月至2016年10月间儿童单侧供肾成人肾移植的临床病例，按照首次肾移植、移植肾动脉与受者髂外动脉端侧吻合的入选标准，回顾性分析14例供、受者的临床资料。按供肾长径将其分为2组，供肾长径〉6 cm者为A组，供肾长径为5-6 cm者为B组，分析14例受者临床疗效及并发症情况，并比较2组受者及移植物存活率、术后移植肾功能、移植肾长径变化和术后并发症。结果A组7例，供肾长径均值（7.5±1.2） cm；B组7例，供肾长径均值（5.7±0.1） cm；14例受者手术均成功，截至随访日期，移植肾及受者均存活。A组与B组术后移植肾功能无明显差异（2组术后第7天、第14天、1个月、2个月、3个月及6个月血肌酐和肾小球滤过率比较，均P〉0.05。A组、B组术后移植肾长径值均出现增加，术后2个月时分别为（9.9±0.6） cm和（10.4±1.5） cm，P〉0.05。14例受者中术后发生移植肾功能恢复延迟（DGF）3例，其中A组2例，B组1例；术后出现蛋白尿7例（50.0%），其中A组2例（28.6%），B组5例（71.4%）；发生血尿4例（28.6%），A组、B组各2例（28.6%）；B组发生急性排斥反应1例，A组未出现急性排斥反应；所有受者术后均未出现血管栓塞、尿漏及肺部感染等并发症，2组受者术后并发症的发生率无明显差异。结论儿童单侧供肾成人肾移植中，将供肾长径的标准扩大到〉5 cm可取得较好的临床效果。但儿童供肾移植术后蛋白尿、血尿的发生率较高，远期临床疗效仍有待进一步研究。

Objective To investigate the clinical outcome of single kidney transplantation from pediatric donors and to explore the application criteria. Methods The clinical data of 14 recipients undergoing renal transplantation from October 2006 to October 2016 were retrospectively analyzed. All the recipients received primary kidney transplantation from pediatric donor and the renal artery was anastomosed with external iliac artery. Based on the length of the kidney donor, the recipients were divided into two groups as group A （length beyond 6 cm） and group B （length 5-6 cm）. The clinical effect and complications of the 14 recipients, the survival of the recipients and grafts, the recovery of renal function, the change of the renal length and the postoperative complications were compared between the two groups. Results The renal length in group A （n = 7） was （7. 5 ±1.2） cm, and （5.7± 0. 1） cm in group B （n = 7）. During the follow-up period, all renal grafts and recipients survived. No significant difference was observed between two groups in renal graft function evaluated by serum creatinine and estimated glomerular filtration rate （eGFR） at 7th day, 14th day, 1st, 2nd, 3rd and 6th month postoperatively, P=0.05. The length of transplanted kidney increased after operation in both groups, with results of 9. 9±0. 6 cm in group A and 10. 4±1. 5 cm in group B （P〉0. 05）, respectively, at 2nd month post transplantation. Delayed graft function （DGF） occurred in 2 cases of group A and 1 case of group B. Seven cases developed proteinuria （50. 0%）, including 2 cases in group A （28. 6%） and 5 cases in group B （71. 4%）. Four cases suffered hematuria （28.6%）, including 2 cases in group A （28.6o/00） and 2 cases in group B （28. 6%）. One recipient in group B suffered acute rejection. No vascular embolization, urine leakage, pulmonary infection and other complications were observed in all the recipients. Conehtsion The length beyond 5 cm is acceptable for single pediatric kidney donor for adult recipients with a promising clinical outcome in short-term. However, the high incidence of proteinuria and b.ematuria remains obstacle, and the long-term outcome needs further exploration.