小于2岁与2~18岁儿童遗体捐献供者供肾儿童单肾移植疗效对比分析  

Comparative analysis of single pediatric kidney transplantation from pediatric donors between donors aged <2 years and 2-18 years

作　　者：冯润桃 赵明[1] 胡建敏[1] 周松 廖俊 李子健 刘永光[1] Feng Runtao;Zhao Ming;Hu Jianmin;Zhou Song;Liao Jun;Li Zijian;Liu Yongguang(Department of Organ Transplantation,Zhujiang Hospital,Southern Medical University,Guangzhou 510280,China)

机构地区：[1]南方医科大学珠江医院器官移植科,广州510280

出　　处：《中华器官移植杂志》2024年第12期878-884,共7页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金(82170764)。

摘　　要：目的比较分析小于2岁低龄儿童与2~18岁儿童遗体捐献供者供肾行儿童单肾移植的疗效。方法回顾2016年8月至2023年5月在南方医科大学珠江医院器官移植科实施的127例儿童遗体捐献供者供肾儿童单肾移植的临床资料。其中,供者年龄小于2岁的低龄儿童供肾(small pediatric donors,SPD)组22例和供者年龄在2~18岁的儿童供肾(normal pediatric donors,NPD)组105例。对比分析两组供受者的基线资料、术后并发症发生情况和受者及移植物存活情况。结果SPD组和NPD组供者年龄[11.0(10.0,15.0)月与121.0(74.0,166.0)月]、供者体重[8.3(8.0,9.4)kg与30.0(20.0,50.0)kg]和供受者体重比[0.3(0.2,0.5)与1.0(0.6,1.5)]比较,差异均有统计学意义(P值均<0.001);供者性别、供肾类型、冷热缺血时间、人类白细胞抗原错配数及供者获取前估算的肾小球滤过率比较,差异均无统计学意义(P值均>0.05)。SPD组和NPD组受者性别、年龄、体重、移植次数、术前透析方式、术前诱导方式、术前群体反应性抗体水平及原发病情况比较,差异均无统计学意义(P值均>0.05)。SPD组和NPD组术后血管血栓形成发生率和出血发生率比较[9.1%(2/22)比0和13.6%(3/22)比1.9%(2/105)],差异有统计学意义(P=0.029和0.036);原发肾病复发、移植物功能延迟恢复及移植后1年内急性排斥反应累计发生率比较,差异无统计学意义(P值均>0.05)。SPD组发生移植物丢失6例(27.3%),原因为原发性无功能1例、血管血栓形成2例、术后出血2例以及血栓性微血管病1例。NPD组发生移植物丢失3例(2.9%),原因为排斥反应2例和感染性移植动脉破裂1例。SPD组和NPD组受者3年存活率分别为100%和99.0%,差异无统计学意义(P=0.600)。SPD组3年死亡删失移植物存活率均为77.3%,低于NPD组的91.5%,差异有统计学意义(HR=8.3,95%CI:2.0~34.2,P<0.001)。结论本中心儿童遗体捐献供肾儿童单肾移植的整体疗效良好,但相对NPD组受者,SPD�Objective To compare the efficacy of single kidney transplantation(KT)from pediatric donors between donors aged<2 and 2-18 years.Methods Between August 2016 and May 2023,127 single pediatric kidney transplantations involving pediatric donors were conducted.They were assigned into two subgroups based upon age of small pediatric donors(n=22,SPD,donors aged<2 years)and normal pediatric donors(n=105,NPD,donors aged 2-18 years).A retrospective analysis was performed to compare recipient/donor baseline characteristics,postoperative complications and recipient/graft survival rates between two groups.Results Significant inter-group differences existed in donor age[11.0(10.0,15.0)vs 121.0(74.0,166.0)month],donor weight[8.3(8.0,9.4)vs 30.0(20.0,50.0)kg]and graft-to-recipient weight ratio[0.3(0.2,0.5)vs 1.0(0.6,1.5)](P<0.001).Conversely,no significant inter-group differences existed in donor gender/type,warm/cold ischemic time,human leukocyte antigen mismatch number,estimated glomerular filtration rate,recipient gender/age/weight,number of transplants,preoperative dialysis,preoperative induction therapy,panel-reactive antibody or primary disease(P>0.05).The incidence of vascular thrombosis was 9.1%(2/22)and 0 in SPD and NPD groups with statistically significant differences(P=0.029);the incidence of post-transplant hemorrhage was 13.6%(3/22)and 1.9%(2/105)with statistically significant difference(P=0.036).However,no statistically significant inter-group differences existed in recurrent renopathy,delayed graft function or 1-year cumulative incidence of acute rejection(P>0.05).Six recipients(27.3%)in SPD group lost allografts due to recurrent or primary nonfunction(n=1),vascular thrombosis(n=2),post-transplant hemorrhage(n=2)and thrombotic microangiopathy(n=1).In comparison,three recipients(2.9%)in NPD group lost allografts due to rejection(n=2)and infectious rupture of transplanted renal artery(n=1).Three-year recipient survival rates were 100%and 99.0%in SPD and NPD groups with no statistically significant differences(P=0.60

关 键 词：儿童 肾移植 器官捐献 血栓形成 术后出血 排斥反应 

分 类 号：R726.9[医药卫生—儿科]