儿童供肾儿童肾移植147例临床分析

Clinical analysis of 147 cases of pediatric kidney transplantation with kidney donation after death of minors

目的参考肾移植有关质量控制指标,分析儿童器官捐献供者给儿童受者肾移植临床可行性和疗效。方法回顾2011年9月至2019年9月海军军医大学附属长海医院器官移植科接受儿童供肾的147例儿童肾移植临床资料,分别就供、受者一般情况、受者/移植物存活率和手术并发症等有关方面进行小结。147例移植受者中位年龄130个月(21~207个月),中位体重26.0 kg(8.5~71.5 kg)。120例供者中位年龄12个月(4d^180个月),中位体重9.3 kg(2.5~50.0 kg)。结果经过10 d^9年的随访,受者/移植物累积存活率分别为97.3%和88.8%,其中双肾整块移植受者和移植物累积存活率为95.7%和60.9%,单侧肾移植受者和移植物累积存活率为96.8%和94.2%。双肾整块移植的主要并发症是移植物血栓形成(47.8%)和输尿管并发症(17.4%),而单侧肾移植则以移植物功能延迟恢复(18.6%)和急性排斥反应(10.5%)为主。双肾整块移植和单侧肾移植中导致移植物丢失的主要原因均为移植肾血栓形成。受者死亡4例,其中2例因供者来源感染死亡,1例因巨细胞病毒感染性肺炎合并肝炎导致死亡,1例因癫痫大发作呼吸心博骤停死亡。结论儿童供肾儿童肾移植总体疗效良好。做好供、受者匹配及手术方式最优化选择非常重要。预防术后血栓形成避免早期移植物丢失仍是儿童供肾儿童肾移植移植研究的重点。

Objective To explore the feasibility and efficacy of kidney transplantation with pediatric donors to pediatric recipients(PTP)according to the quality control parameters of kidney transplantation in China.Methods From September 2011 to September 2019,the clinical data were reviewed for 147 children undergoing kidney transplantation.The general status of donors and recipients,survival rate and complications of transplantation were analyzed.The median age was 130(21-270)month and the median weight 26.0(8.5-71.5)kg.The median age of 120 donors was 12 month(4 day-180 month)and the median weight 9.3(2.5-50.0)kg.Results After a follow-up period of 10 days to 9 years,the cumulative survival rates of patients and grafts were 97.3%and 88.8%.The cumulative survival rates of patients and grafts were 95.7%and 60.9%in en bloc kidney transplant recipients versus 96.8%and 94.2%in single kidney transplant recipients.The major complications of en bloc kidney transplantation were graft thrombosis(47.8%)and ureteral complications(17.4%).Single kidney transplantation was characterized by delayed graft function recovery(DGF,18.6%)and acute rejection reaction(10.5%).Two cases died from donor-derived infection after transplantation,one from cytomegalovirus infection and one from epileptic seizure.Conclusions PTP kidney transplantation is effective.Organ matching and optimal operative mode selection are essential.Preventing postoperative thrombosis for avoiding an early graft loss has remained a high priority during PTP kidney transplantation.