儿童肾移植111例报道

Kidney transplantation in children: a report of 111 cases

目的通过对单中心儿童受者肾移植疗效的总结,探讨安全有效扩大供肾来源与提高儿童肾移植成功率的举措。方法2002年9月至2019年9月,华中科技大学同济医院附属同济医院器官移植研究所实施儿童肾移植(受者年龄<18岁)111例,根据成人供肾41例及儿童供肾70例分为两个大组,前者又分为亲属活体供肾19例及器官捐献供肾22例两个亚组,后者分为单侧供肾移植48例及双侧供肾移植22例两个亚组。回顾性分析其临床资料和移植预后。结果成人供肾组受者年龄为(15.6±1.9)岁,亲属活体供肾组术后发生移植物功能恢复延迟0例,器官捐献供肾组6例(27.3%),两组差异有统计学意义(P<0.05)。随访22~181个月,移植肾1、5年存活率在亲属活体供肾组和器官捐献供肾组之间差异无统计学意义(1年:100%比94.1%;5年:93.8%比94.1%)。儿童供肾组的供者年龄在单侧供肾组和双侧供肾组分别为6(0.6,60.0)个月和0.5(0.1,2.0)个月(P<0.05),受者年龄分别为(9.5±5.3)岁和(11.5±1.8)岁,差异无统计学意义(P>0.05),其中包括<1岁的婴儿受者肾移植7例。单侧供肾移植组3例(6.3%)发生血栓,双侧供肾移植组5例(22.7%)发生血栓,差异无统计学意义(P=0.06)。随访4~54个月,移植肾1、2年存活率在单侧供肾组为85%和80%,在双侧供肾组为75%和70%(组间差异无统计学意义)。除血栓形成外,导致儿童移植肾功能丧失的其他原因包括急性排斥反应和原发病复发等。儿童移植受者1年存活率在单侧供肾组为98%,双侧供肾组为95%。结论成人供肾给大龄患儿可获得满意疗效,儿童供肾给儿童受者的移植肾存活率有待进一步提高,尤其对新生儿供肾,应在充分评估风险后使用。

Objective To summarize the transplant outcomes of pediatric kidney transplantation at a single center and discuss probable measures of improving the outcomes.Methods A total of 111 pediatric renal transplantation were performed from September 2002 to September 2019.They were divided into adult-donor group(n=41)and pediatric-donor group(n=70).Adult-donor group consisted of two subgroups based upon donor sources:living-donor group(n=19)and deceased-donor group(n=22).Pediatric-donor group consisted of two subgroups based upon surgical types:single kidney group(n=48)and en bloc kidney group(n=22).Clinical data and outcomes of grafts and recipients were retrospectively analyzed.Results The average age of recipients was(15.6±1.9)years in adult-donor group.None developed delayed graft function(DGF)in living-donor group whereas 6 patients(27.3%)had DGF in deceased-donor group(P<0.05).During a follow-up period of 22-181 months,1-year and 5-year graft survivals were 100%vs 94.1%and 93.8%vs 94.1%in living-donor and deceased-donor groups respectively.There were no statistical differences.In pediatric-donor group,the age of donors was significantly lower in en bloc subgroup than that in single kidney subgroup(median:0.5 vs 6 months,P<0.05).The age of recipients was similar between two subgroups:(9.5±5.3)years in single kidney group vs.11.5±1.8 years in en bloc kidney group.In addition,7 cases of single kidney were transplanted for infant recipients aged under 1 year.Vascular thrombosis occurred in 3 patients(6.3%)of single kidney group,less than that in 5 patients(22.7%)of en bloc kidney group(P=0.06).During a follow-up period of 4-54 months,1-year and 2-year graft survivals were 85%and 80%in single kidney group whereas 75%and 70%in en bloc kidney group.However,there was no statistically significant difference.One-year survival was 98%in single kidney group and 95%in en bloc kidney group.Conclusions For elder pediatric recipients,excellent kidney transplant outcomes may be achieved with grafts from adult donors.For pediatric kidney recipients,transplant outcomes can be further improved with careful assessments and cautious usage of small grafts,particularly those form neonatal donors.