Mahdavi Reza, Arab Davood, Taghavi Rahim, Gholamrezaie Hamid Reza, Yazdani Mohammad, Simforoosh Nasser, Tabibi Ali
Department of Kidney Transplantation, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
Urol J. 2006 Spring;3(2):82-6.
The shortage of cadaveric donors for kidney transplantation has led to the expansion of the criteria used for donor selection, such as the use of pediatric cadaveric donors. In this study we reviewed our results of en bloc kidney transplantation of pediatric cadaveric donors to adults.
From May 2001 to May 2005, 245 cadaveric kidney transplants have been performed in our hospitals. Seven of these were en bloc kidney transplantations in adult recipients from marginal pediatric donors (age < 5 years, donor weight < 15 kg, high creatinine clearance, or kidney length < 8 cm). We reviewed their records. Follow-up (range, 3 to 24 months) included ultrasonography, dimercaptosuccinic acid renal scintigraphy, and magnetic resonance imaging.
Serum levels of creatinine ranged between 0.8 m/dL to 1.9 mg/dL during the follow-up period. One patient died of myocardial infarction 3 months postoperatively. One-year graft and patient survivals were both 85.7%. Complications included acute tubular necrosis in 1 patient (managed by conservative therapy and dialysis for 2 weeks), renal vein thrombosis in 1 (treated by anticoagulation), and subcutaneous hematoma in 1. There were no urologic complications. Median size of the grafts was 7.2 cm preoperatively that reached 9.6 cm, 3 months postoperatively (P = .018). Twelve months following operation, the median size of the grafts reached 11 cm (P = .045).
En bloc pediatric kidney transplantation is a safe and suitable alternative for adult recipients. One-year graft and patient survivals are acceptable and complication rate is low.
肾移植尸体供体的短缺导致了供体选择标准的扩大，例如使用小儿尸体供体。在本研究中，我们回顾了我们将小儿尸体供体整块肾移植给成人的结果。
2001年5月至2005年5月，我们医院共进行了245例尸体肾移植。其中7例是将边缘小儿供体（年龄<5岁，供体体重<15 kg，肌酐清除率高或肾长<8 cm）的肾脏整块移植给成年受者。我们回顾了他们的记录。随访（范围为3至24个月）包括超声检查、二巯基琥珀酸肾闪烁显像和磁共振成像。
随访期间血清肌酐水平在0.8 m/dL至1.9 mg/dL之间。1例患者术后3个月死于心肌梗死。1年移植肾和患者生存率均为85.7%。并发症包括1例急性肾小管坏死（通过保守治疗和透析2周处理）、1例肾静脉血栓形成（采用抗凝治疗）和1例皮下血肿。无泌尿系统并发症。术前移植肾的中位大小为7.2 cm，术后3个月达到9.6 cm（P = 0.018）。术后12个月，移植肾的中位大小达到11 cm（P = 0.045）。
小儿肾脏整块移植是成年受者一种安全且合适的选择。1年移植肾和患者生存率可接受，并发症发生率低。
