Asano T, Shiraga H, Akioka Y, Hattori M, Ishikawa N, Tanabe K, Toma H, Ito K
Department of Pediatric Nephrology, Tokyo Women's Medical University, Japan.
Nihon Jinzo Gakkai Shi. 2000 May;42(4):327-32.
Renal transplantation is considered to be the optimal replacement therapy for children with end-stage renal disease. However, the number of pediatric renal transplants in Japan is much lower than in the USA and/or Europe. Since October 1997, pediatric(< 15 years) recipients are given priority over adult recipients for organ sharing, only if one or two HLA-DR antigen(s) are matched between the recipient and pediatric(< 15 years) donor. However, the number of pediatric transplants is not increasing. One hundred and twenty-four pediatric renal transplantations were performed in Tokyo Women's Medical University between 1983 and 1999, of which 18(14.5%) were cadaveric transplants and the others (106, 85.5%) were living-related transplants. We examined 18 pediatric cadaveric renal transplantations. Seven patients received their graft from pediatric donors less than 15 years of age and 11 from adult donors. The mean age at transplantation was 13.2 years (range 4.5-18.7 years). Major etiologies of renal disease are hereditary renal disease(38.8%), chronic glomerulonephritis(33.3%), and focal segmental glomerulosclerosis[FSGS] (16.7%). Zero matches in HLA-DR locus were observed in 72.2%. Patient survival rate was 100%. Graft survival rates at 1 and 5 years after transplantation were 83% and 64% successively. There was no significant difference between the graft survival of cadaveric and living-related transplantation at 1 and 5 years. All 5 patients who received their graft between 1994 and 1998 have maintained normal graft function. Causes of their graft loss were chronic rejection in 3, recurrence of FSGS in 2, primary non-function in 1, and graft thrombosis in 1. Donor age and HLA-DR mismatching did not affect the outcome. We propose that pediatric renal grafts should be provided to children with priority, regardless of their HLA-A, B and HLA-DR matching.
肾移植被认为是终末期肾病患儿的最佳替代治疗方法。然而，日本小儿肾移植的数量远低于美国和/或欧洲。自1997年10月起，仅当受体与小儿（<15岁）供体之间有一或两个HLA - DR抗原匹配时，小儿（<15岁）受体在器官分配上优先于成人受体。然而，小儿移植的数量并未增加。1983年至1999年间，东京女子医科大学共进行了124例小儿肾移植，其中18例（14.5%）为尸体供肾移植，其余106例（85.5%）为亲属活体供肾移植。我们对18例小儿尸体供肾移植进行了研究。7例患者接受了小于15岁小儿供体的移植物，11例接受了成人供体的移植物。移植时的平均年龄为13.2岁（范围4.5 - 18.7岁）。肾病的主要病因是遗传性肾病（38.8%）、慢性肾小球肾炎（33.3%）和局灶节段性肾小球硬化[FSGS]（16.7%）。72.2%的患者在HLA - DR位点无匹配。患者生存率为100%。移植后1年和5年的移植物生存率分别为83%和64%。尸体供肾移植和亲属活体供肾移植在1年和5年时的移植物生存率无显著差异。1994年至1998年间接受移植物的所有5例患者均维持了正常的移植物功能。移植物丢失的原因分别为慢性排斥3例、FSGS复发2例、原发性无功能1例和移植物血栓形成1例。供体年龄和HLA - DR错配不影响结果。我们建议，小儿肾移植物应优先提供给儿童，而不论其HLA - A、B和HLA - DR匹配情况如何。
