婴幼儿单供肾移植给成人受者的尝试与研究19例  

Single kidney transplantation from pediatric donors younger than 3 years to adult recipients

作　　者：朱兰[1] 付程[1] 杜敦峰[1] 刘斌[1] 陈松[1] 张伟杰[1] 曾凡军[1] 林正斌[1] 蒋继贫[1] 陈知水[1] 陈刚[1] 

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卫生计生委/教育部器官移植重点实验室,武汉430030

出　　处：《中华器官移植杂志》2016年第1期11-15,共5页Chinese Journal of Organ Transplantation

摘　　要：的探讨小于3岁婴幼儿公民逝世后供者器官捐献（DCD）供单侧移植肾给成人受者的早期效果。方法总结自2014年9月1日至2015年9月1日间实施的婴幼儿DCD供单肾成人受者肾移植19例的资料。结果供者年龄为（18．0±6．1）个月（8±26个月），其中小于1岁供者4例。供者体重为（11．6±5．2）kg，供肾纵轴长（6．3±0．6）cm。19例成人受者的年龄为（30．0±9．6）岁，体重为（45．8±6．2）kg，受者中女性为13例（68．4％）。除1例为再次肾移植外，其他受者均为初次肾移植。19例受者术后发生移植肾功能恢复延迟3例（16％），其他受者术后早期尿量满意但术后1个月内血肌酐下降速度较缓慢，之后估算肾小球滤过率稳定增加，至术后1年时达（91．3±20．7）ml·min^-1·1．73m^-2。随访期间发生急性排斥反应1例，治疗后好转；肺部感染6例，其中导致死亡2例。结论通过选择合适的受者，婴幼儿供单肾成人肾移植能够取得满意的早期移植效果，可为扩大供肾来源提供新的途径。Objective To investigate the early outcome of the single kidney transplantation from pediatric cadaver donors younger than 3 years to adult recipients. Method From 2014. 9 to 2015. 9, a total of 19 single kidney transplants from pediatric donation after citizen death （DCD） donors younger than 3 years to adult recipients were performed and the data were summarized. Result The average age of donors was 18. 0 ± 6. 1 months （ranging 8-26 mofiths）, with 4 donors younger than 1 year. The average donor weight was 11.6 ± 5.2 kg, and the average kidney length was 6. 3 ± 0. 6 cm. For the 19 adult recipients, the average age was 30. 0 ± 9. 6 years, the average body weight was 45.8 ± 6. 2 kg, and the number of female patients was 13 （68. 4%）. All except one of these patients were transplanted for the first time. Delayed graft function （DGF） was observed in 3 patients （16%）. The rest of recipients had a satisfied urine output immediately after the small single kidney transplantation, however, the serum creatinine levels decreased relatively slower in the early period. The average value of eGFR could be steadily increased to normal within the 1-year follow-up period （91.3 ± 20. 7 mL. min^-1.1.73 m^-2）. Additionally, only one renal graft developed acute rejection （5 %）, which was successfully reversed by the treatment of high dose of steroids. Pulmonary infection occurred in 6 re- cipients, which led to recipient death among two of them. Conclusion By choosing appropriate adult recipients, excellent short-period transplant outcome can he achieved by using small single kidneys from pediatric donors younger than 3 years, which may represent an important way to expand the do- nor pool for kidney transplantation.

关 键 词：肾移植 儿童 供者 移植物存活 

分 类 号：R726.9[医药卫生—儿科] R699.2[医药卫生—临床医学]