Tejani A, Sullivan E K
Department of Pediatrics and Surgery, New York Medical College, Valhalla, USA.
Pediatr Transplant. 2000 May;4(2):140-5. doi: 10.1034/j.1399-3046.2000.00099.x.
Since 1991, more than 50% of pediatric transplant recipients have received a living donor (LD) kidney, and approximately equals 85% of these allografts were one-haploidentical parental kidneys. Short-term (1 yr) and long-term (5 yr) graft survival of LD kidneys are 10% and 15% better, respectively, than that of cadaver donor (CD) kidneys. Because of these results, children are frequently not placed on a cadaver waiting list until the possibility of a LD is excluded--a process that may take up to 1 yr. The hypothesis for this study was that the graft outcome of a six-antigen-matched CD kidney is superior to that of a one-haploidentical LD kidney, and that children are at a disadvantage by not being placed on a CD list whilst waiting for a LD. The database of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) for 11 yrs (1987-98), was reviewed to identify children who were recipients of a six-antigen-matched CD kidney (primary and repeat transplants), and those who were recipients of a one-haploidentical LD kidney (primary and repeat transplants). Using standard statistical methods, the morbidity, rejection episodes, post-transplant hospitalizations, renal function, long- and short-term graft survival, and half-life of primary recipients were compared in the two groups. Unlike adult patients, only 2.7% (87/3313) of CD recipients in the pediatric age range received a six-antigen-matched kidney, and the annual accrual rate over 11 yrs was never higher than 4%. Comparison of 57 primary six-antigen-CD kidneys (PCD) with 2,472 primary LD (PLD) kidneys revealed that morbidity, rejection rates, and ratios were identical in the two groups. Renal function and subsequent hospitalizations were also identical in the two groups. Five-year graft survival of the PCD group was 90% compared with 80% for the PLD group, and the half-life of the PCD group was 25 +/- 12.9 yrs compared with 19.6 +/- 1.3 yrs. Our data suggest that the six-antigen-matched CD kidney may have less graft loss as a result of chronic rejection and would therefore confer a better long-term outcome. Based on these findings we recommend that all children, whilst waiting for a LD work-up, be listed with the United Network for Organ Sharing (UNOS) registry for a CD kidney.
自1991年以来，超过50%的儿科肾移植受者接受了活体供者（LD）肾脏移植，其中约85%的移植肾为单倍体相合的亲体肾脏。LD肾移植的短期（1年）和长期（5年）移植肾存活率分别比尸体供者（CD）肾移植高10%和15%。鉴于这些结果，在排除活体供肾可能性之前，儿童通常不会被列入尸体供肾等待名单——这一过程可能长达1年。本研究的假设是，六个抗原匹配的CD肾移植结果优于单倍体相合的LD肾移植，且儿童在等待LD肾时未被列入CD肾等待名单会处于不利地位。回顾了北美儿科肾移植协作研究（NAPRTCS）11年（1987 - 1998年）的数据库，以确定接受六个抗原匹配的CD肾移植（初次和再次移植）的儿童，以及接受单倍体相合的LD肾移植（初次和再次移植）的儿童。采用标准统计方法，比较了两组初次受者的发病率、排斥反应次数、移植后住院情况、肾功能、移植肾的长期和短期存活率以及半衰期。与成年患者不同，儿科年龄范围内的CD肾移植受者中只有2.7%（87/3313）接受了六个抗原匹配肾移植，11年期间的年累积率从未超过4%。57例初次六个抗原匹配的CD肾移植（PCD）与2472例初次LD肾移植（PLD）的比较显示，两组的发病率、排斥率及比例相同。两组的肾功能及后续住院情况也相同。PCD组的5年移植肾存活率为90%，而PLD组为80%；PCD组的半衰期为25±12.9年，而PLD组为19.6±1.3年。我们的数据表明，六个抗原匹配的CD肾因慢性排斥导致的移植肾丢失可能较少，因此长期结果可能更好。基于这些发现，我们建议所有儿童在等待LD肾评估期间，在器官共享联合网络（UNOS）登记处登记等待CD肾。
