Neu Alicia M
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
Adv Chronic Kidney Dis. 2006 Jan;13(1):62-9. doi: 10.1053/j.ackd.2005.10.001.
Pediatric and adult kidney transplantation differ in many ways, but one of the most significant differences is the impact of kidney disease and kidney transplantation on growth and development in pediatric patients. Multiple facets of transplantation may have an impact on growth and development, including the timing of transplantation, choice of immunosuppressive agents, and the presence of hypertension. In addition, graft function has a significant impact on linear growth, and so preservation of function becomes important not only for general health and quality of life but also for optimizing growth. Other concerns in pediatric kidney transplantation include a heightened risk for posttransplantation infectious complications, including lymphoproliferative disease. In addition, the impact of immunosuppressive drugs on adherence to therapy is important. Although adherence is a complex and multifactorial process, immunosuppressive drugs that cause physical side effects may contribute to drug nonadherence because children, and particularly adolescents, may be inclined to stop taking medications associated with physical changes that differentiate them from their peers. Studies that further delineate factors that affect growth and development, risk for infectious complications, and nonadherence will be important to maximize outcomes in pediatric kidney transplantation.
小儿肾移植和成人肾移植在很多方面存在差异，但最显著的差异之一是肾脏疾病和肾移植对小儿患者生长发育的影响。移植的多个方面可能会对生长发育产生影响，包括移植时间、免疫抑制剂的选择以及高血压的存在。此外，移植肾功能对线性生长有显著影响，因此保护肾功能不仅对总体健康和生活质量很重要，对优化生长也很重要。小儿肾移植中的其他问题包括移植后感染并发症（包括淋巴增殖性疾病）的风险增加。此外，免疫抑制药物对治疗依从性的影响也很重要。尽管依从性是一个复杂的多因素过程，但引起身体副作用的免疫抑制药物可能会导致药物不依从，因为儿童，尤其是青少年，可能倾向于停止服用与使他们与同龄人不同的身体变化相关的药物。进一步阐明影响生长发育、感染并发症风险和不依从性的因素的研究，对于最大限度提高小儿肾移植的疗效至关重要。
