Fontana I, Ginevri F, Arcuri V, Basile G, Nocera A, Beatini M, Bonato L, Barocci S, Bertocchi M, Manolitsi O, Valente R, Draghi P, Gusmano R, Valente U
Department of Transplantation, San Martino Hospital, University of Genoa, Italy.
Pediatr Transplant. 1999 Aug;3(3):206-9. doi: 10.1034/j.1399-3046.1999.00017.x.
From June 1985 to December 1998, 173 pediatric renal transplants were carried out in 170 patients at our center. From this pool, 73 patients (34 males and 39 females) with a follow-up of 48 months were examined. In all patients, ureteroneocystostomy was performed according to the Lich-Grégoire procedure. All patients were treated with cyclosporin A (CsA)-based immunosuppression, including prednisone and sometimes azathioprine (AZA). Six months after transplantation, voiding cystography (VCU) was performed in all patients and reflux was classified from Grade I to Grade IV. The patients were divided into two groups: those with reflux (Group A: 25 patients) and those without (Group B: 48 patients). Grade I reflux was found in four patients, Grade II in seven patients, Grade III in seven patients, and Grade IV in seven patients. All the patients with severe reflux (Grade IV) underwent a corrective surgical procedure. Both groups were examined for immunologic and non-immunologic risk factors and no significant differences were found. Analysis of patient and graft survival rates revealed no statistical differences (NS) between Groups A and B. Mean serum creatinine (mg/dL) was 1.06 +/- 0.28 and 1.12 +/- 0.41 at 4 yr in Groups A and B, respectively (NS). Mean calculated creatinine clearance (cCrC; ml/min) was 76.74 +/- 15.92 and 77.96 +/- 15.66 in Groups A and B, respectively (NS). The analysis was further extended by considering the grade of reflux (I to IV). Again, no significant differences in the above parameters emerged between the reflux sub-groups; only in the Grade IV sub-group was a slight decrease in cCrC detected, although this difference was not statistically significant when compared with the other sub-groups. In conclusion, vesico-ureteral reflux (VUR) does not seem to negatively affect graft function. However, as all severe reflux patients (Grade IV) were surgically corrected, no conclusions can be drawn with regard to the influence of Grade IV reflux on long-term graft function.
1985年6月至1998年12月，我们中心对170例患者实施了173例小儿肾移植手术。从这些患者中，选取了73例（34例男性和39例女性）随访48个月的患者进行检查。所有患者均按照利奇 - 格雷瓜尔手术方法进行输尿管膀胱吻合术。所有患者均接受以环孢素A（CsA）为基础的免疫抑制治疗，包括泼尼松，有时还使用硫唑嘌呤（AZA）。移植后6个月，对所有患者进行排尿性膀胱尿道造影（VCU）检查，并将反流分为I级至IV级。患者分为两组：有反流的患者（A组：25例）和无反流的患者（B组：48例）。发现4例患者为I级反流，7例为II级，7例为III级，7例为IV级。所有重度反流（IV级）患者均接受了矫正手术。对两组患者的免疫和非免疫危险因素进行检查，未发现显著差异。患者和移植肾存活率分析显示，A组和B组之间无统计学差异（NS）。A组和B组在4年时的平均血清肌酐（mg/dL）分别为1.06±0.28和1.12±0.41（NS）。A组和B组的平均计算肌酐清除率（cCrC；ml/min）分别为76.74±15.92和77.96±15.66（NS）。通过考虑反流程度（I至IV级）进一步扩展分析。同样，反流亚组之间在上述参数上未出现显著差异；仅在IV级亚组中检测到cCrC略有下降，尽管与其他亚组相比，这种差异无统计学意义。总之，膀胱输尿管反流（VUR）似乎不会对移植肾功能产生负面影响。然而，由于所有重度反流患者（IV级）均接受了手术矫正，因此无法就IV级反流对长期移植肾功能的影响得出结论。
