儿童单侧供肾成人肾移植单中心疗效分析

Clinical efficacy of adult kidney transplantation from unilateral pediatric donor kidney

目的探讨儿童单侧供肾用于成人肾移植的临床疗效。方法回顾性分析肾移植儿童供者(10例)及成人受者(19例)的临床资料。比较受者术后1、7、14、28、60 d肾功能、肝功能、移植肾长径变化情况;分析受者的近期生存情况及术后并发症的发生情况。结果供者男6例,女4例,年龄(7±3)岁,体质量指数(BMI)为(16.3±3.8)kg/m^(2),均为脑-心双死亡器官捐献。受者男12例,女7例,年龄(34±12)岁,BMI为(20.3±1.3)kg/m^(2)。受者取右下腹斜形切口,将供肾动、静脉与受者髂外动、静脉端侧吻合,供肾输尿管与受者膀胱吻合,吻合完毕放置右侧髂窝并固定。肾移植受者术后1周血清肌酐和血尿素氮水平下降,2周时接近正常水平。术后受者肝功能各项指标正常。术后1个月移植肾长径为(9.5±0.3)cm,基本达到成人正常值。19例受者术后1年生存率为95%。1例受者发生肺部感染,治疗无效死亡。2例发生排斥反应,1例发生泌尿系统感染,治疗后均痊愈。结论儿童单侧供肾用于成人受者肾移植安全可行,临床效果良好,可作为扩大供肾来源的有效途径。

Objective To evaluate the clinical efficacy of adult kidney transplantation from unilateral pediatric donor kidney.Methods Clinical data of pediatric donors(n=10)and adult recipients(n=19)undergoing kidney transplantation were retrospectively analyzed.The changes of renal function,liver function and the maximal diameters of the kidney allografts were compared at 1,7,14,28,60 d after operation.The short-term survival and incidence of postoperative complications of the recipients were analyzed.Results Ten donors included 6 males and 4 females,aged(7±3)years old,with a body mass index(BMI)of(16.3±3.8)kg/m^(2).All donors were donation after brain death followed by cardiac death.Among 19 recipients,12 were males and 7 were females,aged(34±12)years old,with a BMI of(20.3±1.3)kg/m^(2).An oblique incision was created in the lower right abdomen of the recipients.The arteries and veins of donor kidney were anastomosed with the external iliac arteries and veins of the recipients.The ureter of donor kidney was anastomosed with the bladder of the recipients.After anastomosis,the kidney was placed and fixed in the right iliac fossa.The serum creatinine and blood urea nitrogen levels of the recipients were decreased at 1 week after kidney transplantation,and restored to normal range at postoperative 2 weeks.All parameters related to liver function were normal after operation.At postoperative 1 month,the maximal diameters of the kidney allografts were(9.5±0.3)cm on average,which basically reached those of normal adults.The 1-year survival rate of 19 recipients was 95%.One recipient died from pulmonary infection after ineffective treatment.Two recipients developed rejection,and 1 recipient experienced urinary system infection,who were healed after corresponding treatment.Conclusions Adult kidney transplantation from unilateral pediatric donor kidney is safe,feasible and effective,which can be utilized to enlarge the source of donor kidneys.