供肾婴幼儿和青少年肾移植并发症及其疗效  

Complications and efficacy of kidney transplantation in children and adolescents with infant donors

作　　者：谢红昌[1] 易明 丰永花[1] 王志刚[1] 王军祥[1] 刘磊[1] 李金锋[1] 文建国[2] 庞新路[1] 尚文俊[1] 丰贵文[1] Xie Hongchang;Yi Ming;Feng Yonghua;Wang Zhigang;Wang Junxiang;Liu Lei;Li Jinfeng;Wen Jianguo;Pang Xinlu;Shang Wenjun;Feng Guiwen(Department of Kidney Transplantation,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Center of Pediatric Urodynamics,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院肾移植科,450052 [2]郑州大学第一附属医院小儿尿动力中心,450052

出　　处：《中华实用儿科临床杂志》2021年第21期1614-1617,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的分析供者体质量≤15 kg供肾婴幼儿肾移植的临床资料,探讨婴幼儿供者匹配儿童受者(PTP)儿肾分配策略下的移植的疗效和并发症。方法收集2010年8月至2019年12月在郑州大学第一附属医院开展供肾婴幼儿肾移植的临床资料。分析供受体临床资料、术后并发症、术后肾功能恢复及人、肾存活情况。结果共入组50例婴幼儿供者,93例儿童受者。其中单肾移植(SKT)89例,双肾整块移植(EBKT)4例。围术期主要并发症为肾功能延迟恢复(5/93例,5.4%)和移植肾血管栓塞(3/93例,3.2%),其他有原发性肾病复发(3/93例,3.2%)、呼吸道感染(3/93例,3.2%)和急性排斥反应(2/93例,2.2%)。随访期内受者死因主要为呼吸道感染(4/93例,4.3%)。除死亡造成肾脏丢失外,排斥反应(2/93例,2.2%)、原发性肾病复发(2/93例,2.2%)是造成移植肾丢失的主要原因。术后血肌酐均进行性下降,由术前(824.77±150.24)μmol/L降至术后1个月(90.73±47.24)μmol/L。SKT组随访时间中位数为31个月(3~74个月),受者术后1、3、5年人、肾存活率分别为97.5%/94.2%、96.0%/88.8%、93.1%/86.1%;EBKT组随访时间中位数为50个月(13~65个月),受者术后第1、3、5年人、肾存活率均为100.0%。随访期内2组受者人/肾存活率比较,差异均无统计学意义(均P>0.05),移植效果良好。结论郑州大学第一附属医院肾移植科开展的供肾婴幼儿单/双肾移植效果良好,且PTP儿肾分配策略下肾移植术后并发症发生率并不增加,手术安全可靠。Objective To retrospectively analyze clinical data of infant donors with body weight≤15 kg into children recipients,and to investigate the efficacy and complications under the strategy of pediatric donor to pediatric recipient(PTP)of pediatric kidney transplantation allocation.Methods Clinical data of kidney transplantation for children with infant donors performed in the First Affiliated Hospital of Zhengzhou University from August 2010 to December 2019 were collected.Clinical data of donors and recipients,postoperative adverse events,postoperative renal recovery,and human and renal survival were analyzed.Results A total of 50 infant donors and 93 pediatric recipients were enrolled in this study.Recipients included 89 patients with single kidney transplantation(SKT)and 4 with en-bloc kidney transplantation(EBKT).The major perioperative complications were delayed graft function(DGF)(5 cases,5.4%)and vascular thrombosis(VT)(3 cases,3.2%),followed by recurrence of primary nephropathy(3 cases,3.2%),respiratory tract infection(3 cases,3.2%),and acute rejection(AR)(2 cases,2.2%).During the follow-up period,the main cause of death was respiratory tract infection(4 cases,4.3%).Except for the cause of death,the main causes of graft loss were rejection(2 cases,2.2%)and recurrence of primary kidney disease(2 cases,2.2%).Serum creatinine decreased progressively from(824.77±150.24)μmol/L preoperatively to(90.73±47.24)μmol/L 1 month postoperatively.In SKT group,the median follow-up time was 31 months(3-74 months),and the survival rates of recipients and transplanted kidneys at 1,3 and 5 years postoperatively were 97.5%/94.2%,96%/88.8%and 93.1%/86.1%,respectively.In EBKT group,the median follow-up time was 50 months(13-65 months),and the survival rates of recipients and transplanted kidneys at 1,3 and 5 years postoperatively were all 100.0%.During the fo-llow-up period,there was no significant difference in the human/kidney survival rate between groups(all P>0.05),and well acceptable transplantation outcomes were obtaine

关 键 词：婴幼儿供肾 终末期肾病 肾移植 儿童 

分 类 号：R726.9[医药卫生—儿科]