Wu Wei-zhen, Ye Li-yan, Tan Jian-ming, Ou Liang-ming, Lin Rong-xi
Department of Urology, Fuzhou General Hospital of Nanjin Military Region, Fuzhou 350025, China.
Zhonghua Er Ke Za Zhi. 2003 Nov;41(11):804-7.
The survival rate of cadaveric renal transplant in children has been improved following the development of transplantation technology and the application of immunosuppressive agents. In this study, the prognosis of renal transplantation, operative procedure and immunosuppressive agents administration in 21 children with end-stage renal disease (ESRD) were analyzed.
From January 1985 to December 2001, 21 patients (9 males and 12 females with a mean age of 14 +/- 2 yr, mean body weight of 33.4 kg and mean height of 136.5 cm) received renal transplantation because of ESRD were enrolled in the study. The patients with an average GFR of 8.28 ml/min were managed with dialysis for 13.4 months in average pro-transplantation. All cadaveric kidneys were from adults, which included 1 donor with one HLA mismatch, 3 with two mismatches, 5 with three mismatches and 4 with four mismatches. All transplantations were performed with anastomoses of the adults' renal artery and vein to the children's iliac externa artery and iliac externa vein. Biological inducement therapy was given in 4 cases. At the first 3 - 5 days post-transplantation, methylprednisolone was administered [7 mg/(kg.d)]. All patients received baseline diploid or triple immunosuppression therapy of cyclosporin A [6 - 8 mg/(kg.d)] or FK506 [0.18 - 0.25 mg/(kg.d)], mycophenolate mofetil [MMF 10 - 15 mg/(kg.d)] or azathioprine [1 - 3 mg/(kg.d)] and prednisone [0.4 - 0.6 mg/(kg.d)]. High-dose methylprednisolone [10 mg/(kg.d)] was administered to control the acute rejection.
The renal function of patients was restored 5.6 days in average after transplantations. The 1st, 3rd and 5th year survival rates of recipient/graft were 95.2%/95.2%, 86.7%/73.3% and 72.7%/63.6%, respectively. One case had super-acute renal rejection, 5 cases had acute rejection, 3 cases had delayed graft function and 3 patients died. The longest survival time was 12 years. The major complications included hypertension (47.6%), diabetes (19.4%), infection (19.4%) and drug-induced hepatic injury (14.2%). Catch-up growth was seen in most of the pediatric recipients.
Renal transplantation is the most ideal method to treat children with ESRD, and the growth of the pediatric patients will be improved after transplantation. Adult donor kidneys adapt to the school age patient. And the protocol of immunosuppressive therapy (prednisone plus MMF and FK506) should be applied.
随着移植技术的发展和免疫抑制剂的应用，儿童尸体肾移植的存活率有所提高。本研究分析了21例终末期肾病（ESRD）患儿肾移植的预后、手术操作及免疫抑制剂的使用情况。
1985年1月至2001年12月，纳入21例因ESRD接受肾移植的患者（9例男性，12例女性，平均年龄14±2岁，平均体重33.4 kg，平均身高136.5 cm）。患者平均肾小球滤过率（GFR）为8.28 ml/min，移植前平均接受透析13.4个月。所有尸体肾均来自成人，其中1例供体有1个HLA错配，3例有2个错配，5例有3个错配，4例有4个错配。所有移植手术均将成人肾动脉和肾静脉与儿童髂外动脉和髂外静脉进行吻合。4例采用生物诱导治疗。移植后最初3 - 5天，给予甲泼尼龙[7 mg/(kg·d)]。所有患者接受环孢素A[6 - 8 mg/(kg·d)]或他克莫司[0.18 - 0.25 mg/(kg·d)]、霉酚酸酯[MMF 10 - 15 mg/(kg·d)]或硫唑嘌呤[1 - 3 mg/(kg·d)]以及泼尼松[0.4 - 0.6 mg/(kg·d)]的基础二联或三联免疫抑制治疗。给予大剂量甲泼尼龙[10 mg/(kg·d)]以控制急性排斥反应。
移植后患者肾功能平均5.6天恢复。受者/移植物的1年、3年和5年存活率分别为95.2%/95.2%、86.7%/73.3%和72.7%/63.6%。1例发生超急性肾排斥，5例发生急性排斥，3例发生移植肾功能延迟恢复，3例患者死亡。最长存活时间为12年。主要并发症包括高血压（47.6%）、糖尿病（19.4%）、感染（19.4%）和药物性肝损伤（14.2%）。大多数儿童受者出现追赶生长。
肾移植是治疗儿童ESRD最理想的方法，移植后儿童患者的生长情况会得到改善。成人供肾适合学龄期患者。应采用免疫抑制治疗方案（泼尼松加MMF和他克莫司）。
