Eneriz-Wiemer Monica, Sarwal Minnie, Donovan Danny, Costaglio Cathy, Concepción Waldo, Salvatierra Oscar
Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA 94304, USA.
Transplantation. 2006 Nov 15;82(9):1148-52. doi: 10.1097/01.tp.0000236644.76359.47.
Inferior vena cava (IVC) thrombosis is generally a contraindication to renal transplantation in small children because of the technical difficulty and limitations in allograft venous outflow drainage that risk graft thrombosis.
The records of six consecutive children (9.9-27.4 kg) with end-stage renal disease and thrombosed IVCs were reviewed. Small deceased donor renal allografts were utilized in all cases where immediate posttransplant venous renal outflow would theoretically not exceed the drainage capacity of the iliac or adjacent pelvic collateral veins.
There is 100% patient survival with two patients returning to dialysis at seven and three years posttransplantation. There were no surgical complications or delayed graft function. Postoperatively, progressive renal vein and simultaneous iliac venous enlargement was observed in five of six recipients concomitant with renal allograft enlargement. In these patients, maximum renal volume achieved was between 152 and 275 ml and last recorded Schwartz glomerular filtration rates ranged from 67 to 118 ml/min. The sixth allograft had an early, severe rejection episode that limited renal growth and attainment of good renal function. All patients demonstrated resumption of growth rates commensurate with age but without significant catch-up growth.
A small deceased donor kidney can provide freedom from dialysis and better quality of life for small children with IVC thrombosis during an age when dialysis treatment is difficult and the complications of the thrombosed IVC may compromise life. Good renal function was attained in patients without rejection episodes. In those with rejection, our approach allowed for patient growth during allograft function, providing a bridge for a repeat transplant.
由于技术难度以及同种异体移植静脉流出道引流的局限性，存在移植肾血栓形成的风险，下腔静脉（IVC）血栓形成通常是小儿肾移植的禁忌证。
回顾了6例终末期肾病合并IVC血栓形成患儿（体重9.9 - 27.4千克）的病历。在所有理论上移植后即刻肾静脉流出量不超过髂静脉或相邻盆腔侧支静脉引流能力的情况下，均使用了小体型脑死亡供者的肾移植物。
患者生存率为100%，2例患者分别在移植后7年和3年重新开始透析。无手术并发症或移植肾功能延迟恢复。术后，6例受者中有5例在肾移植增大的同时，观察到肾静脉逐渐增宽以及髂静脉同步增宽。在这些患者中，达到的最大肾体积在152至275毫升之间，最后记录的施瓦茨肾小球滤过率范围为67至118毫升/分钟。第6例移植肾发生了早期严重排斥反应，限制了肾脏生长及良好肾功能的获得。所有患者均表现出生长速率恢复至与年龄相称的水平，但无显著的追赶生长。
对于患有IVC血栓形成的小儿，在透析治疗困难且血栓形成的IVC并发症可能危及生命的年龄段，小体型脑死亡供者的肾脏可使患儿摆脱透析并提高生活质量。未发生排斥反应的患者获得了良好的肾功能。对于发生排斥反应的患者，我们的方法使患者在移植肾功能期间得以生长，为再次移植搭建了桥梁。
