婴幼儿肾移植疗效及预后分析  

Efficacy and prognosis of infant kidney transplantation

作　　者：朱兰 郭志良[1] 赵大强 萨如拉 赵光远 张瑜 仇丽茹 周建华 李伟杰[4] 郭晖 沈芸妍[5] 李晓忠 陈知水 陈刚[1,2] Zhu Lan;Guo Zhiliang;Zhao Daqiang;Sa Rula;Zhao Guangyuan;Zhang Yu;Qiu Liru;Zhou Jianhua;Li Weijie;Guo Hui;Shen Yunyan;Li Xiaozhong;Chen Zhishui;Chen Gang(Institute of Organ Transplantation,Tongji Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;The Key Laboratory of Organ Transplantation,the Ministry of Education,the Key Laboratory of Organ Transplantation,National Health Commission,the Key Laboratory of Organ Transplantation,Chinese Academy of Medical Sciences,Wuhan 430030,China;Department of Pediatrics,Tongji Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Department of Pharmacy,Tongji Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Department of Renal Immunology Affiliated to Children′s Hospital of Soochow University,Suzhou 215000,China)

机构地区：[1]华中科技大学同济医学院附属同济医院器官移植研究所,武汉430030 [2]器官移植教育部重点实验室,国家卫生健康委员会器官移植重点实验室,中国医学科学院器官移植重点实验室,武汉430030 [3]华中科技大学同济医学院附属同济医院儿科,武汉430030 [4]华中科技大学同济医学院附属同济医院药学部,武汉430030 [5]苏州大学附属儿童医院肾脏免疫科,苏州215000

出　　处：《中华医学杂志》2023年第38期3010-3016,共7页National Medical Journal of China

摘　　要：目的分析婴幼儿肾移植的疗效及预后。方法回顾性收集华中科技大学同济医学院附属同济医院2017年6月1日至2022年7月31日实施的37例次3岁以内婴幼儿受者肾移植临床资料,初次肾移植31例次,二次肾移植6例次。中位随访18个月(6~66个月)。采用Kaplan-Meier法绘制移植肾及受者生存曲线,分析预后及并发症情况。结果受者男20例,女17例,中位年龄16个月(2个月26 d至36个月),中位体重8 kg(3.2~14.0 kg),最小仅2个月26 d,体重仅3.2 kg。受者原发病最多见为先天性肾病综合征(13例,41.9%)。19例次(51.3%)为腹腔内移植,余18例次(48.6%)为髂窝内移植。术后发生移植肾功能恢复延迟7例次(18.9%),血栓形成并导致移植肾失功5例(13.5%),其中4例接受二次肾移植并获得成功。在随访期间内,急性排斥反应11例(29.7%),巨细胞病毒肺炎6例(16.2%)。患儿移植后1年的估算肾小球滤过率高于术后1个月[(101.9±22.1)比(71.1±25.6)ml/(min·1.73m^(2)),P<0.001],并在术后2年时保持恒定。移植肾1年、2年存活率均为85.3%,移植受者1年、2年存活率均为96.8%。结论尽管婴幼儿肾移植实施难度较大,但还是能够取得相对满意疗效和预后。Objective To analyze the effect and prognosis of infant kidney transplantation.Methods Clinical data of 37 cases of infant kidney transplantation under 3 years old in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from June 1,2017 to July 31,2022 were retrospectively collected.These 37 cases included 31 primary kidney transplantation and 6 secondary kidney transplantation.Kaplan-Meier method was used to draw the survival curve of the transplanted kidney and the recipient,and the prognosis and complications were analyzed.Median follow-up was 18 months(range:6-66 months).Results The recipients were 20 males and 17 females,with a median age of 16 months(range:2 months,26 days to 36 months)and a median weight of 8 kg(range:3.2 to 14.0 kg).The youngest child was only 2 months,26 days old,and weighed only 3.2 kg.The most common primary disease of recipients was congenital nephrotic syndrome(13 cases,41.9%).Intra-abdominal transplantation occurred in 19 cases(51.3%)and intra-iliac fossa transplantation occurred in the remaining 18 cases(48.6%).Postoperative renal function recovery was delayed in 7 cases(18.9%),and thrombosis caused renal function loss in 5 cases(13.5%),of which 4 cases received second renal transplantation and were successful.During the follow-up period,there were 11 cases of acute rejection(29.7%)and 6 cases of CMV pneumonia(16.2%).The estimated glomerular filtration rate 1 year after transplantation was higher than that 1 month after surgery[(101.9±22.1)vs(71.1±25.6)ml/(min·1.73m^(2)),P<0.001],and remained constant 2 years after transplantation.Both the 1-year and 2-year survival rates of the transplanted kidney were 85.3%,and both the 1-year and 2-year survival rates of the recipients were 96.8%.Conclusion Although the implementation of infant kidney transplantation is difficult,it can still achieve relatively satisfactory efficacy and prognosis.

关 键 词：肾移植 儿童 血栓形成 排斥反应 随访研究 

分 类 号：R726.9[医药卫生—儿科]