低龄婴儿双供肾移植给成人22例报道

En-bloc kidney transplantation from small infant donors to adult recipients:a report of 22 cases

目的总结单中心低龄婴儿双供肾移植给成人的临床效果。方法回顾性纳入2013年7月至2017年10月华中科技大学同济医学院附属同济医院实施的所有儿童双供肾移植给成人受者共22例临床资料和随访数据。22例供者年龄(2.9±1.7)个月,体重(4.9±1.4)kg,其中15例小于3月龄。受者多为低体重女性成人,体重(46.3±5.6)kg。总结早期移植失败及随访期间移植肾失功或受者死亡原因。根据是否发生单侧移植肾血栓,移植肾功能恢复者又进一步分为双肾存活组和单肾存活组,比较移植肾中-长期功能。结果4例受者在术后早期出现移植失败,包括双肾血栓2例、移植肾破裂切除1例和受者多器官功能衰竭死亡1例。18例受者移植肾功能恢复出院,随访期间因移植肾新生肿瘤切除双肾1例、因复杂全身原因死亡1例、因间质性肺炎死亡1例,余15例受者双肾均存活者10例(中位随访59个月),单肾存活者5例(中位随访48个月)。移植1年时双肾存活组估算肾小球滤过率为(95±27)ml/(min·1.73 m2),显著高于单肾存活组(61±24)ml/(min·1.73 m2)(P<0.05),但3年时分别为(95±21)ml/(min·1.73 m2)和(69±31)ml/(min·1.73 m2),差异缩小,差异无显著统计学意义(P=0.12)。结论低龄婴儿双供肾移植虽然可以扩大供肾来源,但发生早期移植失败和单肾栓塞的风险较高。在单肾存活的情况下,受者仍具有相对满意的中-长期移植效果。

Objective To summarize the clinical outcomes of en-bloc kidney transplantation from small infant donors to adult recipients at a single center.Methods A total of 22 en-bloc transplantations from pediatric donors to adult recipients were performed from July 2013 to October 2017 in Institute of Organ Transplantation Affiliated Tongji Hospital Tongji Medical College Huazhong University of Science.Clinical data were retrospectively analyzed.The average age of 22 donors was(2.9±1.7)months with an average weight of(4.9±1.4)kg and 15 of them were aged under 3 months.The average weight of 22 adult recipients was(46.3±5.6)kg and most recipients were female.The causes of early graft failure and recipient death were examined during follow-ups.The recipients with functioning grafts post-transplantation were divided into single kidney survival group and en-bloc kidney survival group based upon the occurrence of unilateral vascular thrombosis.Medium/long-term renal graft function was compared between two groups.Results Early graft failure occurred in 4 recipients.The causes were bilateral renal vascular thrombosis(n=2),renal rupture(n=1)and multiple organ failure followed by death(n=1).Eighteen recipients were discharged after a recovery of renal graft function.One case had a removal of bilateral renal grafts due to new-onset graft tumor and another two died from interstitial pneumonia and complicate systematic disorder respectively during follow-ups.Among the remaining 15 recipients,10 achieved bilateral renal survival(median follow-up:59 months)and 5 unilateral renal survival(median follow-up:48 months).The average eGFR of bilateral renal survival group was significantly higher than that of unilateral renal survival group at Year 1 post-transplantation(95±27 vs 61±24 ml/min/1.73 m2,P<0.05)while the gap narrowed at Year 3 and there was no statistical significance(95±21 vs 69±31 ml/min/1.73 m2,P=0.12).Conclusions Although en-bloc kidney transplantation from infant donors can expand organ donor pool,there is a higher risk of early graft failure and unilateral renal vascular thrombosis.Nevertheless,satisfactory renal transplant outcomes may be achieved in patients with unilateral renal graft survival.