婴幼儿供肾成人双肾移植42例  

Dual kidney transplantation from infant donors to adult recipients:a report of 42 cases

作　　者：汤周琦 刘慧聪[2] 彭龙开[1] 谢续标[1] 代贺龙 陈靖靓 吴妮 桂珊珊 胡善彪[1] 余少杰[1] Tang Zhouqi;Liu Huicong;Peng Longkai;Xie Xubiao;Dai Helong;Chen Jingliang;Wu Ni;Gui Shanshan;Hu Shanbiao;Yu Shaojie(Department of Kidney Transplantation,Organ Transplantation Center,The Second Xiangya Hospital of Central South University,Clinical Research Center for Organ Transplantation in Hunan Province,Transplant Medicine Research Center of The Second Xiangya Hospital of Central South University,Changsha 410011,China;Operation Room,The Second Xiangya Hospital of Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院器官移植中心肾脏移植科,中南大学湘雅二医院移植医学研究中心,湖南省器官移植临床医学研究中心,长沙410011 [2]中南大学湘雅二医院手术室,长沙410011

出　　处：《中华器官移植杂志》2021年第1期14-19,共6页Chinese Journal of Organ Transplantation

摘　　要：目的回顾性分析单中心婴幼儿供肾成人双肾移植临床疗效,探讨供、受者选择及不同手术方式的效果差异。方法回顾性总结2012年12月至2019年5月中南大学湘雅二医院实施的婴幼儿供肾成人双肾移植42例,根据供肾是否满足三"5"标准(供者年龄>5个月、供者体重>5 kg、供肾长径>5 cm)分为两组,两组受者再根据采用不同的手术方式分为术式A亚组(经典En-bloc术式)、术式B亚组(分离式双肾移植)、术式C亚组(改良术式)。分析其临床资料及预后。结果经中位随访时间56个月(11~92个月)。供肾满足三"5"标准组受者均未发生栓塞事件;末次随访估算肾小球滤过率:术式A为123.4 ml/min(92.2~156.6 ml/min)、术式B为97.2 ml/min(81.3~116.6 ml/min)、术式C为133.9 ml/min(133.9~133.9 ml/min);供肾不满足三"5"标准的受者中,术式A和术式C受者均未发生栓塞事件(0%),术式B中3例受者发生移植物栓塞(2例单肾栓塞、1例双肾栓塞)(3/5,60%),显著高于术式A、C组(P<0.05);末次随访尿蛋白(+):术式A 1例(1/2,50%)、术式B 3例(3/5,60%),术式C 0例,术式C受者尿蛋白阳性率显著低于术式A、B(P<0.05);末次随访估算肾小球滤过率:术式A为82.4 ml/min(80.9~83.9 ml/min)、术式B为71.8 ml/min(46.1~114.2 ml/min)、术式C为122 ml/min(83.3~142.4 ml/min)。满足三"5"标准供者组和不满足三"5"标准供者组的受者1年移植肾存活率分别为100%和89.5%;3年移植肾存活率分别为100%和84.2%。结论婴幼儿供肾可以加以利用,满足三"5"标准的供肾对术式的要求不高,预后较好;不满足三"5"标准的极低龄、极低体重供者的供肾,采用利用主动脉远端建立流出道的改良术式似可降低栓塞的发生率、改善近期预后,并减轻移植物高灌注损伤、改善远期预后。Objective To explore the clinical efficacy of single-center infant kidney donor adult dual kidney transplantation to explore the difference of different operation methods and the operation options of different donor kidney conditions so as to improve the success rate of children kidney donor adult dual kidney transplantation and reduce complications.Methods A total of 42 cases of infant and adult dual kidney transplantations at Department of Kidney Transplantation in The Second Xiangya Hospital of Central South University from December 2012 to May 2019 were divided into two groups according to whether or not donor kidney fulfilled the criteria of three"5".According to different surgical approaches,they were divided into three groups of A(classical En-Bloc operation),B(separated dual kidney transplantation)and C(modified operation).The clinical data and prognoses were analyzed.Results The median follow-up period was 55(11-92)months.The estimated glomerular filtration rate was 123.4(92.2-156.6)ml/min for operation A,97.2(81.3-116.6)ml/min for operation B and 133.9(133.9-133.9)ml/min for operation C.In donor group not fulfilling the"5"principle,no thrombotic event occurred for operation A/C and 3 cases of transplantation for operation B.There were single renal embolism(n=2)and dual renal embolism(n=1)(3/5,60%)(P<0.05).Urinary protein was positive in the last follow-up:operation A(1/2,50%)and operation B(3/5,60%)(P<0.05).The estimated glomerular filtration rate at the last follow-up was 82.4(80.9-83.9)ml/min for operation A,71.8(46.1-114.2)ml/min for operation B and 122(83.3-142.4)ml/min for operation C.The 1-year graft survival rate was 100%and 89.5%in three"5"donor group and 3-year graft survival rate was 100%and 84.2%respectively.Conclusions Satisfactory outcomes might be obtained during dual kidney transplantation for infants and adults.The incidence of thrombosis,urine leakage and urinary protein is lower in improved kidney transplantation group than that in previously operated group.The problem of graft hyperpe

关 键 词：肾移植 儿童供肾 栓塞 

分 类 号：R726.9[医药卫生—儿科]