Bharat Winston, Manlhiot Cedric, McCrindle Brian W, Pollock-BarZiv Stacey, Dipchand Anne I
Labatt Family Heart Centre, Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
Pediatr Transplant. 2009 Feb;13(1):111-8. doi: 10.1111/j.1399-3046.2007.00848.x. Epub 2007 Dec 18.
To assess the burden over time of renal dysfunction in pediatric heart transplant patients using an objective measure on an annual basis for serial comparison. GFR was measured at regular interval by nuclear medicine scintigraphy. Results were analyzed in relation to age, time post-transplantation, gender, and average calcineurin-inhibitor dose for the first two months post-transplantation. Results were compared with cGFR using the Schwartz equation. A total of 91 patients (56 males) transplanted between 1990 and 2004 underwent 373 GFR measurements. Median age at transplantation was 3.3 yr (birth - 17.8). Median first GFR at 0.7 yr (0.1-4.1) post-transplant was normal (94 mL/kg/1.73 m(2)). Freedom from at least mild renal insufficiency was 84% and 33% at one and five years post-transplant. Females had better renal function early post-transplant (GFR 105 mL/min/1.73 m(2)) but an increased probability of an abnormal GFR over time. Higher calcineurin inhibitor dose in the first two months post-transplantation was associated with an increasing probability of an abnormal GFR over time. The cGFR overestimated the measured GFR by 33 +/- 26 mL/kg/1.73 m(2). Renal insufficiency is an important morbidity after pediatric transplantation with the majority of patients experiencing at least mild renal dysfunction. Calculated GFR significantly underestimates the burden of renal insufficiency in this patient population.
为了通过每年一次的客观测量进行连续比较,评估小儿心脏移植患者肾功能障碍随时间的负担。通过核医学闪烁扫描定期测量肾小球滤过率(GFR)。分析结果与年龄、移植后时间、性别以及移植后头两个月的钙调神经磷酸酶抑制剂平均剂量的关系。使用施瓦茨方程将结果与估算肾小球滤过率(cGFR)进行比较。1990年至2004年间共91例患者(56例男性)接受了心脏移植,共进行了373次GFR测量。移植时的中位年龄为3.3岁(出生至17.8岁)。移植后0.7年(0.1 - 4.1年)时首次GFR的中位数正常(94 mL/kg/1.73 m²)。移植后1年和5年时至少无轻度肾功能不全的比例分别为84%和33%。女性在移植后早期肾功能较好(GFR为105 mL/min/1.73 m²),但随着时间推移GFR异常的可能性增加。移植后头两个月较高的钙调神经磷酸酶抑制剂剂量与随着时间推移GFR异常的可能性增加相关。cGFR比测量的GFR高估了33±26 mL/kg/1.73 m²。肾功能不全是小儿移植后的重要发病情况,大多数患者至少经历轻度肾功能障碍。计算得到的GFR显著低估了该患者群体中肾功能不全的负担。