Offner G, Latta K, Hoyer P F, Baum H J, Ehrich J H, Pichlmayr R, Brodehl J
Kinderklinik der Medizinischen Hochschule Hannover, Germany.
Kidney Int. 1999 Apr;55(4):1509-17. doi: 10.1046/j.1523-1755.1999.00356.x.
The aim of renal replacement therapy in children is to restore their potential for normal growth and development in order to reach mature adulthood. Because pediatric kidney transplantation started in the late 1960s, it is now possible to document the progress and outcome of these patients from transplantation in childhood to survival into adulthood.
In this single-center study, all 150 children born before December 1977 and having received a kidney transplant between 1970 and 1993 were selected for long-term follow-up. The mean age at transplantation was 12.1 years (range 3.2 to 16.7), and the mean follow-up was 13.1 years (range 2.0 to 25.0). In December 1995, 124 grown-up patients with a mean age of 25.4 years (range 18.4 to 40.3) were alive, 89 with a functioning graft. Fifty had the first graft functioning longer than 10 years. The fate of all patients was traced, and those living were analyzed in regard to their somatic and socioeconomic states.
The actuarial 25-year survival rate for the patients was 81%, and for the first graft it was 31%. The best graft survival rates were observed after living related donation, preemptive transplantation, and immunosuppression with cyclosporine. The latter benefit, however, vanished after eight years. The mean creatinine clearance declined over the years from 76 to 45 ml/min/1.73 m2, and the incidence of hypertension increased to more than 80% of the patients. Malignancies occurred in 2.6%. Final height was stunted in 44% of noncystinotic patients, whereas all patients with cystinosis were extremely growth retarded. Twenty-seven percent suffered from additional disabilities. A majority of adult patients were rehabilitated in regard to education and socioeconomic status, and 14% were unemployed.
The results indicate that renal transplantation in children leads to a high degree of rehabilitation in adulthood. The life of a kidney transplant, however, is limited, which points out the need for more specific immunosuppression with fewer side-effects in order to reach the goal of lifelong graft function.
儿童肾替代治疗的目的是恢复其正常生长发育的潜力，以便成年。自20世纪60年代末开展小儿肾移植以来，现在已有可能记录这些患者从儿童期移植到成年存活的过程和结果。
在这项单中心研究中，选取了1977年12月前出生且在1970年至1993年间接受肾移植的所有150名儿童进行长期随访。移植时的平均年龄为12.1岁（范围3.2至16.7岁），平均随访时间为13.1年（范围2.0至25.0年）。1995年12月，124名成年患者存活，平均年龄25.4岁（范围18.4至40.3岁），其中89人移植肾仍有功能。50人的首次移植肾功能维持超过10年。追踪了所有患者的转归，并对存活患者的身体和社会经济状况进行了分析。
患者的25年精算生存率为81%，首次移植肾的生存率为31%。活体亲属供肾移植、抢先移植以及使用环孢素免疫抑制后的移植肾生存率最佳。然而，8年后这种益处消失。多年来，平均肌酐清除率从76降至45 ml/min/1.73 m²，高血压发病率增至超过80%的患者。恶性肿瘤发生率为2.6%。44%的非胱氨酸病患者最终身高发育迟缓，而所有胱氨酸病患者生长严重受限。27%的患者有其他残疾。大多数成年患者在教育和社会经济地位方面得到康复，14%的患者失业。
结果表明儿童肾移植可使成年期高度康复。然而，移植肾的寿命有限，这表明需要更具特异性且副作用更少的免疫抑制，以实现移植肾长期存活的目标。
