Keown P A, Shackleton C R, Ferguson B M
Department of Medicine, University of British Columbia, Canada.
Eur J Pediatr. 1992;151 Suppl 1:S70-5. doi: 10.1007/BF02125807.
Driven by the technological and immunological innovations of the past decade, paediatric transplantation has evolved quickly to occupy an important clinical role in the management of vital organ failure. With this success, the focus of clinical attention has moved progressively from an institutional to a more comprehensive community perspective, and the long-term success of transplantation has assumed greater importance in the evaluation of risk and benefit. Five-year patient survival now exceeds 90% after living donor or cadaveric renal transplantation, 70% following heart or liver transplantation, and approaches 60% at 2 years for the more developmental procedures of heart/lung and lung transplantation. Successful transplantation is accompanied by compelling evidence of improved quality of life. The earliest and most prominent gain is in physical capability, with a progressive re-establishment of social and psychological functioning compared to age-appropriate developmental norms. More than 75% of long-term recipients are in school or employed with a high rating of life satisfaction. Rehabilitation is threatened, however, by the complications of long-standing organ failure and long-term immunosuppression. These principally encompass skeletal and developmental disorders, metabolic abnormalities, cardio-vascular disease, renal dysfunction, and chronic infection or malignancy arising as a result of impaired immune surveillance. Prevention or effective management of these debilitating sequelae is a principal goal in the changing paradigm of organ transplantation for the current decade.
在过去十年技术和免疫学创新的推动下，小儿移植迅速发展，在重要器官衰竭的治疗中占据了重要的临床地位。随着这一成功，临床关注的焦点已逐渐从机构层面转向更全面的社区层面，移植的长期成功在风险和益处评估中变得更加重要。活体供体或尸体肾移植后五年患者生存率目前超过90%，心脏或肝移植后为70%，而对于心脏/肺和肺移植等更具挑战性的手术，两年时接近60%。成功的移植伴随着生活质量改善的确凿证据。最早也是最显著的收获是身体能力的提升，与适龄发育标准相比，社会和心理功能逐渐恢复。超过75%的长期受者上学或就业，生活满意度较高。然而，长期器官衰竭和长期免疫抑制的并发症威胁着康复。这些主要包括骨骼和发育障碍、代谢异常、心血管疾病、肾功能障碍以及由于免疫监视受损而引发的慢性感染或恶性肿瘤。预防或有效管理这些使人衰弱的后遗症是当前十年器官移植不断变化的模式中的一个主要目标。
