中国儿童肾脏移植等待者评估与管理临床诊疗指南  

Clinical practice guidelines for the evaluation and management of pediatric kidney transplant candi-dates in China

作　　者：中华医学会器官移植学分会 刘龙山[2] 王长希[2] 张桓熙[3] 尚文俊 李军[3] 吴成林[3] Branch of Organ Transplantation,Chinese Medical Association;Liu Longshan;Wang Changxi(不详;Organ Transplant Center,First Affiliated Hospital,Sun Yat-sen University,Guangzhou 510080)

机构地区：[1]不详 [2]中山大学附属第一医院器官移植中心,广州510080 [3]中山大学附属第一医院 [4]郑州大学第一附属医院

出　　处：《中华器官移植杂志》2025年第1期1-25,共25页Chinese Journal of Organ Transplantation

基　　金：广东省高层次人才项目(R09002);广州市临床重大技术项目(2023P-ZD15)。

摘　　要：终末期肾病患儿的移植前评估与管理是儿童肾脏移植技术流程中的关键环节,对明确适应证、移植时机、围手术期处理和随访管理起着决定性作用,甚至影响移植成败。终末期肾病患儿的原发病复杂多样,合并症多且病情变化快,对评估和管理要求更高。中华医学会器官移植学分会组织国内专家,基于国际循证医学标准,制定了本指南,围绕原发病诊断、合并症评估、适应证与禁忌证、移植时机以及等待期管理等方面凝练关键临床问题,并按照《牛津大学循证医学中心分级2009版》的证据分级与推荐意见强度提出循证等级推荐意见,供国内同行参考,旨在促进提高儿童肾脏移植疗效。指南在强调全面评估的同时,特别关注儿童受者的特殊需求,如基因检测在明确原发病中的重要性,以及针对遗传性和先天性疾病的评估与管理。原发病诊断有助于优化适应证选择、制定合理的手术及围手术期管理方案,并降低术后疾病复发风险。指南还阐述了心肺功能、营养状态、感染风险等多系统合并症评估的重要性。该指南为规范临床实践、提高儿童肾脏移植疗效提供了重要依据。Pre-transplant evaluation and management of pediatric patients with end-stage renal disease(ESRD)are critical components in the pediatric kidney transplantation process.They play a decisive role in determining indications,timing of transplantation,perioperative management,and follow-up care,potentially influencing the success of the transplant.Given the complex and diverse of primary diseases,comorbidities,and rapid progression in pediatric ESRD patients,higher standards for their assessment and management are required.Branch of Organ Transplantation,Chinese Medical Association convened national experts to develop this guideline based on international evidence-based medical standards.The guideline focuses on key clinical issues including primary disease diagnosis,comorbidity assessment,indications and contraindications,timing of transplantation,and management during the waiting period.Recommendations are provided according to Oxford Centre for Evidence-Based Medicine 2009 Levels of Evidence for reference by national peers.While emphasizing comprehensive evaluation,the guideline pays special attention to the unique needs of pediatric patients,such as the importance of genetic testing in clarifying primary diseases and the assessment and management of genetic and congenital disorders.Diagnosing the primary disease aids in optimizing the selection of indications,formulating appropriate surgical and perioperative management plans,and reducing the risk of postoperative disease recurrence.The guideline also elaborates on the significance of assessing multisystem comorbidities,including cardiopulmonary function,nutritional status,and infection risk.This guideline provides an important basis for standardizing clinical practice and improving the efficacy of pediatric kidney transplantation.

关 键 词：肾脏移植 儿童 移植前评估 原发病 适应证 合并症 

分 类 号：R726.9[医药卫生—儿科]