38例小儿双供肾成人肾移植临床疗效分析

Early outcomes of en-bloc renal transplantation from pediatric donors:a report of 38 cases

目的总结小儿双供肾移植临床应用数据和经验,探讨改善其移植术后疗效的措施。方法回顾性分析2014年9月至2019年11月华中科技大学同济医学院附属协和医院38例小儿双供肾移植资料,小儿供者年龄(63.6±5.7)d,体重(4.1±0.2)kg,受者年龄(28.1±1.4)岁,体重(48.7±4.9)kg。收集供、受者基本情况与术前检查结果,采集受者术前和术后7、30 d及3、6、12个月的血肌酐水平,记录肾移植术后血栓、尿漏、移植肾功能延迟性恢复、蛋白尿、移植肾周血肿等并发症的发生情况与治疗预后。结果术后1年移植物存活率为76.3%(29/38),移植受者存活率100%(38/38),移植物长期存活的29例受者中,手术2周后均无须透析辅助治疗,术后1年血肌酐水平均降至正常。血栓是最主要的术后并发症。肾动、静脉血栓形成导致肾功能丧失发生率18.4%(7/38),余并发症还包括尿漏20.7%(6/29)、移植肾周血肿6.9%(2/29)、原发性移植肾无功能2.6%(1/38)等。结论小儿供肾作为扩大供肾来源的有效方式,临床应用是可行的。

Objective To summarize the clinical experiences of pediatric en-bloc kidney transplantation(EBKT)at a single center and explore the measures of improving its efficacy.Methods Clinical data and outcomes retrospectively analyzed for 38 EBKT children between September 2014 and November 2019 from Department of Urology Affiliated Union Hospital Tongji Medical College Huazhong University of Science&Technology.The pediatric donors were aged(63.6±5.7)days with a weight of(4.1±0.2)kg.And the transplant recipients were aged(28.1±1.4)years with a weight of(48.7±4.9)kg.Serum levels of creatinine and basic profiles of both donors and recipients were recorded at Day 0/7/30/90/80/360 post-EBKT.The postoperative occurrences of such complications such as thrombosis,urine leakage,delayed graft function(DGF),proteinuria and hematoma were measured.Results The one-year graft survival rate was 76.3%(29/38)and the recipient survival rate 100.0%(38/38).Among 29 recipients with long-term graft survival,no dialysis was required at Week 2 post-EBKT and the serum level of creatinine dropped to normal at Year 1.Thrombosis was a major post-EBKT complication with an incidence of 18.4%(7/38).The other complications included urine leakage(20.7%,6/29),hematoma(6.9%,2/29)and primary non-functioning kidney(2.6%,1/38).Conclusions As an effective way of expanding the pool of donors,pediatric EBKT is clinically feasible.