Hasegawa A, Motoyama O, Shishido S, Ito K, Tsuzuki K, Takahashi K, Ohshima S
Department of Nephrology, Toho University School of Medicine, Tokyo, Japan.
Transplant Proc. 2004 Mar;36(2 Suppl):216S-219S. doi: 10.1016/j.transproceed.2003.12.029.
Ten-year graft survival rate was 89% after immunosuppressive therapy with cyclosporine, methylprednisolone, and mizoribine in pediatric renal transplant recipients enrolled in our multicenter study. Adrenocorticosteroids, which cause growth retardation, were reduced by administration on alternate days in 67% and withdrawn in 23% of recipients. Acute rejection episodes occurred in 30% of patients after withdrawal of steroids. Graft function returned to prerejection levels after treatment with high-dose methylprednisolone. Catch-up growth occurred after alternate day administration and steroid withdrawal. Twenty-eight of 94 patients reached the final height of 156 cm in boys and 145 cm in girls, because of the gradually reduced growth rate. Management of growth retardation before transplantation, especially in patients with congenital renal diseases, and early reduction of the steroid dose after transplantation will increase the final height of children with chronic renal failure.
在我们多中心研究纳入的小儿肾移植受者中，使用环孢素、甲泼尼龙和咪唑立宾进行免疫抑制治疗后，移植物10年生存率为89%。导致生长迟缓的肾上腺皮质类固醇，67%的受者改为隔日给药，23%的受者停用。停用类固醇后，30%的患者发生急性排斥反应。大剂量甲泼尼龙治疗后，移植物功能恢复到排斥前水平。隔日给药和停用类固醇后出现了追赶生长。94名患者中有28名男孩最终身高达到156厘米，女孩达到145厘米，原因是生长速度逐渐减慢。移植前生长迟缓的管理，尤其是先天性肾病患者，以及移植后早期减少类固醇剂量，将增加慢性肾衰竭儿童的最终身高。
