单中心儿童肾移植81例临床特点及并发症相关危险因素分析  

Clinical characteristics and risk factors of complications after kidney transplantation in children at a single-center

作　　者：祝藩原 郑鳕洋 杨璟辉 王纪渊 丁越 陈瑜 韩澍 Zhu Fanyuan;Zheng Xueyang;Yang Jinghui;Wang Jiyuan;Ding Yue;Chen Yu;Han Shu(Department of Organ Transplantation,Second Affiliated Hospital of Naval Medical University,Shanghai 200003,China)

机构地区：[1]海军军医大学第二附属医院器官移植科,上海200003

出　　处：《中华器官移植杂志》2024年第6期391-398,共8页Chinese Journal of Organ Transplantation

摘　　要：目的探讨儿童肾移植受者术后的临床特点及分析并发症相关危险因素。方法回顾性分析2010年1月至2022年9月在海军军医大学第二附属医院器官移植中心接受初次肾移植81例儿童受者的临床资料,观察患儿术后1年内急性排斥反应(acute rejection,AR)、移植物功能延迟恢复(delayed graft function,DGF)、感染、骨髓抑制、肿瘤等并发症的发生情况。根据是否发生AR、DGF对儿童受者进行分组后,用单因素分析推测发生AR、DGF对患儿移植术后1年时肾功能的影响,并采用二元logistic回归分析AR、DGF的相关危险因素。结果随访期间无死亡病例,有5例因移植肾血管栓塞而切除移植肾,恢复透析;1例因原发病复发,导致移植肾失功,恢复透析。余75例移植肾功能恢复良好,随访截止时,移植受者和移植肾的存活率分别为100%(81/81)和92.6%(75/81)。术后有23例(28.4%)儿童受者发生DGF,其中C-I类捐献儿童受者20例;采用抗CD25人源化单克隆抗体进行免疫诱导者21例,采用猪抗人淋巴细胞免疫球蛋白(porcine antihuman lymphocyte immunoglobulin,pALG)者2例(8.7%)。术后一年内有13例(16.1%)儿童受者发生AR,其中C-I类捐献儿童受者11例;采用抗CD25人源化单克隆抗体进行免疫诱导者8例,采用ALG者4例,采用抗人T细胞兔免疫球蛋白者1例。12例经甲泼尼龙冲击治疗后逆转,1例冲击治疗无效,经静脉滴注兔抗人胸腺细胞免疫球蛋白后逆转。有14例(17.3%)肾移植儿童受者术后随访期间发生感染18次。其中,肺部感染7例,上呼吸道感染3例,泌尿道感染5例,胃肠道感染2例,腹腔感染1例。感染病原体中,细菌14例,病毒4例,无真菌感染病例。发生骨髓抑制7例(8.6%),其中白细胞减少6例,血小板减少1例。至随访一年截止时,无恶性肿瘤发生。末次随访时,未发生过AR和DGF儿童受者血肌酐为(72.79±21.07)μmol/L,发生过AR或DGF儿童受者末次随访时血肌酐分别为(68.83±10.78Objective To explore the clinical characteristics and risk factors of pediatric kidney transplantation(KT).Methods From January 1,2010 to September 30,2022,retrospective analysis was performed for the relevant clinical data of 81 pediatric recipients of primary KT at Organ Transplant Center of Shanghai Changzheng Hospital.The occurrences of acute rejection(AR),delayed graft function(DGF),infection,myelosuppression,tumor and other complications were observed within 1 year post-KT.They were grouped according to whether or not AR/DGF occurred.Univariate analysis speculated the effect of AR and DGF on renal function at 1 year after transplantation.Binary Logistic regression was employed for examining the risk factors related to AR/DGF.Results During follow-ups,transplanted kidney was removed due to an embolization of renal vessels and dialysis resumed(n=5).One child had failed graft due to the recurrence of original disease and dialysis resumed.The remaining 75 children had an excellent recovery of graft function.At the end of follow-ups,survival for transplant recipients and transplanted kidneys was 100%(81/81)and 92.6%(75/81)respectively.23 patients(28.4%)developed DGF,including 20 child recipients of C-I donors.Among DGF recipients,21(91.3%)were immune induced with anti-CD25 humanized monoclonal antibody and 2(8.7%)with porcine antihuman lymphocyte immunoglobulin(pALG).Within the first year post-KT,13 patients(16.1%)developed AR,including 11 child recipients of C-I donors.Induction was made with anti-CD25 humanized monoclonal antibody(n=8),pALG(n=4)and anti-human T lymphocyte rabbit immunoglobulin(n=1).And 12 cases were reversed with MP(methylprednisolone)shock therapy while another ineffective case was rescued by an intravenous infusion of rATG(rabbit anti-human thymocyte immunoglobulin).During postoperative follow-ups,14(17.3%)KT recipients had an onset of pulmonary infection(n=7),upper respiratory tract infection(n=3),urinary tract infection(n=5),gastrointestinal infection(n=2)and abdominal cavity infection(n=1

关 键 词：儿童 肾移植 免疫诱导 急性排斥反应 肾功能延迟恢复 

分 类 号：R726.5[医药卫生—儿科]