小儿肾移植患者向成人医疗服务过渡期间的肾移植丢失情况。
Renal allograft loss during transition to adult healthcare services among pediatric renal transplant patients.
作者信息
Koshy Susan M, Hebert Diane, Lam Kelvin, Stukel Therese A, Guttmann Astrid
机构信息
Division of Nephrology, Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada.
出版信息
Transplantation. 2009 Jun 15;87(11):1733-6. doi: 10.1097/TP.0b013e3181a63ed9.
BACKGROUND
Transition to adult care occurs at age 18 during a vulnerable adolescent period for pediatric renal transplant (RTx) patients.
METHODS
We examined renal allograft loss and hospitalization for RTx biopsy or rejection before and after transition to adult care using clinical and administrative health records of children who underwent RTx (1992-2002) in Ontario, Canada. Life-table analyses examined event rates/100 person years according to age at first RTx.
RESULTS
A total of 115 patients were included (57% men; mean age at first transplant 13.9+/-3.7 years). Allograft loss rates were similar across ages 14.0 to 23.9 years. No increase in allograft loss was observed during transition period (ages 18.0-19.9 years). Hospitalizations for RTx rejection or biopsy were much lower after age 18.
CONCLUSIONS
Our findings do not support an increased risk of allograft loss after transition to adult care, although there is less hospital use for rejection or biopsy suggesting that differences exist in use of care before complete allograft loss after transition to adult care.
背景
对于小儿肾移植（RTx）患者而言，在18岁这一脆弱的青少年时期会过渡到成人护理阶段。
方法
我们利用加拿大安大略省接受RTx（1992 - 2002年）儿童的临床和行政健康记录，研究了向成人护理过渡前后RTx活检或排斥反应导致的肾移植失败和住院情况。生命表分析根据首次RTx时的年龄检查了每100人年的事件发生率。
结果
共纳入115例患者（男性占57%；首次移植时的平均年龄为13.9±3.7岁）。14.0至23.9岁各年龄段的移植失败率相似。在过渡阶段（18.0 - 19.9岁）未观察到移植失败增加。18岁以后因RTx排斥反应或活检导致的住院情况大幅减少。
结论
我们的研究结果不支持向成人护理过渡后移植失败风险增加，尽管因排斥反应或活检而住院的情况较少，这表明在向成人护理过渡后直至移植完全失败之前，护理使用方面存在差异。
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