Koch Nogueira Paulo C, Amaral Alexandre S R, Boni Reginaldo, Pereira Luiz A, Pinheiro Machado Paula G, Pestana Jose O M
Faculdade de Ciências Médicas de Santos, Centro Universitário Lusíada-UNILUS, Rua Coronel Lisboa 600, Vila Mariana, São Paulo, Brazil-CEP 04020-041.
Pediatr Transplant. 2004 Oct;8(5):502-6. doi: 10.1111/j.1399-3046.2004.00207.x.
Early kidney transplantation is crucial in order to accomplish both optimal mental development and the best adult height in children with end-stage renal disease. The aim was to evaluate the efficacy of the child priority policy for cadaveric kidney sharing adopted in the State of Sao Paulo (Brazil). We performed a retrospective study of data collected by the Government Transplant Department in São Paulo, involving all patients included in the waiting list from August 13, 1998 to December 31, 2001. During the study period, the child priority policy had been changed giving: period A--from the outset up to March 14, 2001, where the rule was to direct cadaveric kidneys obtained from children <12 yr, to recipients <12 yr; period B--from March 14, 2001 onwards, where the policy had been broadened to include cadaveric donors <18 yr, destined for recipients <18 yr. We performed the analysis of the data comprising 8940 patients, 8622 being adults (mean age = 48.6 +/- 14.1 yr, 3594 females) and 318 children (mean age = 11.9 +/- 5.1 yr, 156 females). Over the 3.5-yr follow-up there were 1964 deaths [1933 adults and 31 children, odds ratio (OR) 0.37; 95% CI 0.25-0.55], 1032 living donor kidney transplants (963 adults and 69 children, OR 2.20; 95% CI 1.66-2.93), and 556 cadaveric kidney transplants (444 adults and 112 children, OR 10.11; 95% CI 7.75-12.94). Three and a half years after being enrolled on the list, 24% of the children and 75% of the adults, respectively, were still awaiting a cadaveric kidney transplant (log rank test = 539, p < 0.00001). The analysis of period A vs. period B, suggests that the raising of the inclusion age upper limit to 18 yr, resulted in a twofold increase in the percentage of children being grafted within 6 months of enrollment. Overall, our data shows a slow rate of cadaveric kidney transplantation activity in Sao Paulo. Children's chances of receiving a living donor kidney almost doubled. Moreover, 19.5% of pediatric recipients had received their kidney within the first year of being enrolled on the waiting list. The scheme adopted in Sao Paulo is encouraging, but the results remain less favorable than those observed in other countries. The adoption of the priority policy did not result in an unacceptable increase of adult waiting time, given that the number of adults on our waiting list outweighs by far the number of children.
早期肾移植对于终末期肾病患儿实现最佳智力发育和达到最佳成人身高至关重要。目的是评估巴西圣保罗州采用的儿童优先尸体肾分配政策的效果。我们对圣保罗州政府移植部门收集的数据进行了回顾性研究，纳入了1998年8月13日至2001年12月31日等待名单上的所有患者。在研究期间，儿童优先政策发生了变化：A期——从开始到2001年3月14日，规定是将12岁以下儿童捐献的尸体肾分配给12岁以下的受者；B期——从2001年3月14日起，政策扩大到包括18岁以下尸体供者的肾，分配给18岁以下的受者。我们对8940例患者的数据进行了分析，其中8622例为成年人（平均年龄 = 48.6±14.1岁，女性3594例），318例为儿童（平均年龄 = 11.9±5.1岁，女性156例）。在3.5年的随访中，有1964例死亡[1933例成年人和31例儿童，比值比（OR）0.37；95%可信区间（CI）0.25 - 0.55]，1032例活体供肾移植（963例成年人和69例儿童，OR 2.20；95%CI 1.66 - 2.93），以及556例尸体肾移植（444例成年人和112例儿童，OR 10.11；95%CI 7.75 - 12.94）。列入等待名单三年半后，分别有24%的儿童和75%的成年人仍在等待尸体肾移植（对数秩检验 = 539，p < 0.00001）。A期与B期的分析表明，将纳入年龄上限提高到18岁，使儿童在登记后6个月内接受移植的百分比增加了两倍。总体而言，我们的数据显示圣保罗尸体肾移植活动的速度较慢。儿童接受活体供肾的机会几乎增加了一倍。此外，19.5%的儿科受者在列入等待名单的第一年内就接受了肾脏。圣保罗采用的方案令人鼓舞，但结果仍不如其他国家观察到的那样理想。鉴于我们等待名单上成年人的数量远远超过儿童数量，采用优先政策并没有导致成年人等待时间出现不可接受的增加。
