Mickelson J J, MacNeily A E, Leblanc J, White C, Gourlay W A
Division of Pediatric Urology, British Columbia Children's Hospital, University of British Columbia, 4480 Oak Street, Vancouver, British Columbia, Canada.
J Urol. 2006 Oct;176(4 Pt 2):1797-800. doi: 10.1016/S0022-5347(06)00612-4.
Small infants are the most challenging group of patients to undergo renal transplantation.
We reviewed the transplantation experience at our institution with children less than 15 kg at transplantation.
We retrospectively reviewed the records of 24 recipients in a 20-year period. Technical and allograft outcomes were compared to those in the North American Pediatric Renal Transplant Cooperative Study database.
Since the inception of our program 24 recipients weighing 15 kg or less who were 6 years or younger have undergone transplantation. Seven grafts (29%) were from living donors. At transplantation mean age was 3.1 years (range 1.8 to 5.7) and mean weight was 13.4 kg (range 9.0 to 15.7). Average cold and warm ischemic times were 14.1 hours (range 3.4 to 37.2) and 23.1 minutes (range 21 to 41), respectively. Early complications were ureteral stricture requiring pyeloureterostomy in 1 case, reversible acute tubular necrosis in 2 and early arterial thrombosis salvaged by immediate thrombectomy in 1. Delayed complications were arterial stenosis requiring angioplasty in 2 cases, and 3 delayed deaths related to malignant hypertension in 2 and sepsis in 1. No grafts were lost due to thrombosis. Mean serum creatinine at years 1 to 3 and 5 were 48.5, 67.5, 79.1 and 84.4 mumol/l, respectively. Graft survival was 92% (22 patients after censoring 1 who died with a functioning graft) at 2 and 5 years. Overall results compare favorably to those in the North American Pediatric Renal Transplant Cooperative Study.
With a multidisciplinary team effort successful results can be achieved in this challenging group of patients.
小婴儿是接受肾移植最具挑战性的患者群体。
我们回顾了本机构对移植时体重不足15千克儿童的移植经验。
我们回顾性分析了20年间24例受者的记录。将技术和移植物结果与北美儿科肾移植协作研究数据库中的结果进行比较。
自我们的项目启动以来，24例体重15千克及以下、年龄6岁及以下的受者接受了移植。7例移植物（29%）来自活体供者。移植时平均年龄为3.1岁（范围1.8至5.7岁），平均体重为13.4千克（范围9.0至15.7千克）。平均冷缺血时间和热缺血时间分别为14.1小时（范围3.4至37.2小时）和23.1分钟（范围21至41分钟）。早期并发症包括1例因输尿管狭窄需行肾盂输尿管吻合术、2例可逆性急性肾小管坏死以及1例通过立即血栓切除术挽救的早期动脉血栓形成。延迟并发症包括2例因动脉狭窄需行血管成形术，以及3例延迟死亡，其中2例与恶性高血压有关，1例与败血症有关。无移植物因血栓形成丢失。1至3年及5年时的平均血清肌酐分别为48.5、67.5、79.1和84.4微摩尔/升。2年和5年时移植物存活率为92%（剔除1例带功能移植物死亡患者后为22例患者）。总体结果与北美儿科肾移植协作研究的结果相比更有利。
通过多学科团队的努力，在这一具有挑战性的患者群体中可以取得成功的结果。
