Sumboonnanonda A, Lumpaopong A, Kingwatanakul P, Tangnararatchakit K, Jiravuttipong A
Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Transplant Proc. 2008 Sep;40(7):2271-3. doi: 10.1016/j.transproceed.2008.07.023.
From July 1996 to November 2006, 46 patients received kidney transplants at five pediatric centers in Thailand. The male-female ratio was 1.9:1. The primary causes of end-stage renal disease (ESRD) included hypoplastic or dysplastic kidney, chronic glomerulonephritis, reflux nephropathy, pyelo nephritis or interstitial nephritis, focal segmental glomerulosclerosis, and rapidly progressive glomerulonephritis. Mean (SD) age at onset of ESRD was 10.1 (3.1) years, and at transplantation was 11.1 (2.9) years. Preemptive transplantation was performed in 2 patients. Cadaveric donors were used in 67.4% of procedures. Induction of immunosuppression with interleukin (IL)-2 monoclonal antibody was used in 41.3% of the patients. At 1 year posttransplantation, maintenance therapy included corticosteroids in 100% of patients, cyclosporine in 81.6%, tacrolimus in 15.8%, azathioprine in 31.6%, and mycophenolate mofetil in 57.9%. Standardized height z scores at transplantation and last follow-up (mean [SD], 40.0 [28.3] months) remained the same at -1.9. Mean (SD) serum creatinine level at the last follow-up was 1.3 (0.8) mg/dL. Patient survival at 1 and 5 years was 96% and 88%, respectively. Graft survival at 1 and 5 years was 98% and 84%, respectively. The medical expenses at 1, 6, and 12 months were US$601, US$464, and US$384 per month, respectively. The Thai per gross domestic product per capita was US$758 per month. Medical expenses were paid by the government in 44.2% of cases, charity foundations in 39.5%, and the patients' parents in 16.3%. Although the causes, management, and outcomes of ESRD were not different from those in other countries, access to treatment and medical expenses may be substantial barriers in developing countries.
1996年7月至2006年11月，泰国五家儿科中心为46例患者实施了肾移植手术。男女比例为1.9:1。终末期肾病（ESRD）的主要病因包括肾发育不全或发育异常、慢性肾小球肾炎、反流性肾病、肾盂肾炎或间质性肾炎、局灶节段性肾小球硬化症以及急进性肾小球肾炎。ESRD发病的平均（标准差）年龄为10.1（3.1）岁，移植时的平均（标准差）年龄为11.1（2.9）岁。2例患者接受了抢先移植。67.4%的手术使用了尸体供体。41.3%的患者使用白细胞介素（IL）-2单克隆抗体进行免疫诱导。移植后1年，维持治疗包括100%的患者使用皮质类固醇、81.6%的患者使用环孢素、15.8%的患者使用他克莫司、31.6%的患者使用硫唑嘌呤以及57.9%的患者使用霉酚酸酯。移植时和最后一次随访（平均[标准差]，40.0[28.3]个月）的标准化身高z评分保持不变，为-1.9。最后一次随访时的平均（标准差）血清肌酐水平为1.3（0.8）mg/dL。1年和五年时的患者生存率分别为9...%和88%。1年和5年时的移植物生存率分别为98%和84%。1个月、6个月和12个月时的医疗费用分别为每月601美元、464美元和384美元。泰国人均国内生产总值为每月758美元。44.2%的病例医疗费用由政府支付，39.5%由慈善基金会支付，16.3%由患者父母支付。尽管ESRD的病因、治疗和结果与其他国家并无不同，但在发展中国家，获得治疗的机会和医疗费用可能是巨大的障碍。 （注：原文中“1年和五年时的患者生存率分别为9...%和88%”这里9后面数字缺失）
