单侧儿童供者供肾用于成人受者移植效果探讨

Study on the effect of unilateral donor kidney donated by child for adult recipient transplantation

目的:评估儿童供者单侧供肾用于成人肾移植效果。方法:回顾性分析郑州大学第一附属医院儿童捐献单侧供肾用于成人肾移植受者病例,术后随访时间大于3年者纳入本研究。将受者分为0~5岁供者组(A组)及6~17岁供者组(B组),其中A组受者体重≤50 kg,B组受者体重≤70 kg。分析供、受者临床资料、受者/移植肾存活情况、移植物功能及生长、并发症情况。结果:共入组45例成人受者,A组12例,B组33例。术后3年受者/移植肾存活率分别为(100%,96.9%)/(91.6%,93.9%)。术后1周B组受者术后早期移植肾功能恢复优于A组,血肌酐差异有统计学意义(P=0.015),其余各随访时间点血肌酐差异无统计学意义(P>0.05)。1年内两组移植物持续生长,1年时均达到成人水平。两组受者并发症发生率差异无统计学意义(P>0.05)。术后1个月两组受者蛋白发生率分别为(33.3%、6.1%),术后1年两组各1例仍存在蛋白尿,术后3年仅A组1例婴儿供肾受者存在蛋白尿。结论:依据受者体重选择合适的供者,儿童单侧供肾移植可为成人尿毒症受者提供良好的移植效果。

Objective To evaluate the effect of unilateral pediatric kidney donation for adult kidney transplantation.Methods Retrospective analysis was conducted on the cases of children who donated unilateral donor kidney for adult kidney transplantation recipients in our hospital,and those who were followed up for more than three years were included in this study.The body weight of the recipients in group A was≤50 kg,and the body weight of the recipients in group B was≤70 kg.The recipients were divided into 0-5 year old donor group(group A)and 6-17 year old donor group(B group).Clinical data,recipient/kidney survival,graft function and growth,and complications of the recipient were analyzed.Results A total of 45 adult recipients were enrolled,including 12 in group A and 33 in group B.The renal survival rate at 3 years after operation was(100%,96.9%)/(91.6%,93.9%).One week after the operation,the early postoperative recovery of renal function in group B was better than that in group A,and the difference of serum creatinine was statistically significant(P<0.05),while the difference of serum creatinine in other postoperative follow-up time points was not statistically significant(P>0.05).Within a year,both groups of grafts continued to grow,reaching adult levels in one year.There was no statistical significance in the incidence of complications between the two groups(P>0.05).The incidence of protein in the two groups was 33.3%and 6.1%,respectively,1 case in each group still had proteinuria at 1 year after surgery,and only 1 case in the infant donor kidney recipient in group A had proteinuria at 3 years after surgery.Conclusions Unilateral donor kidney transplantation from children can provide good results for adult patients with uremia by selecting suitable donors according to the weight of the recipient.