Wisanuyotin Suwannee, Jiravuttipong Apichat
Pediatric Department, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
J Med Assoc Thai. 2009 Dec;92(12):1635-9.
To clarify the demographic data, outcomes and complications of renal transplantation in children at Srinagarind (university) Hospital.
The authors reviewed the medical records of children with end-stage renal disease (ESRD) who received renal transplantation at Srinagarind Hospital, Khon Kaen, between August 2001 and July 2008.
Eight male and seven female patients were identified Their mean age was 12.8 +/- 3.2 years (range, 5.0-17.6). The major cause of ESRD was a congenital anomaly of the kidneys (53%). All of the children received cadaveric transplantations and none received induction therapy. Triple immunosuppressive drugs comprising cyclosporine, prednisolone and mycophenolate mofetil were administered to 12 patients. Tacrolimus, instead of cyclosporine, was given to three patients who had received a renal transplant since January 2008. The median follow-up time was 15 months (3 to 82 months). The most frequent complication was urinary tract infection (40%). Acute graft loss was found in one patient (6.7%) due to graft infarction. Other complications included herpes viral infection, chronic rejection, acute rejection, severe gingival hyperplasia, myopathy, lymphocele and transitional cell carcinoma of the bladder. Two patients returned to dialysis due to graft infarction and chronic rejection, respectively. The mean serum creatinine at the last follow-up of the remaining cases was 1.2 +/- 0.5 mg/dL (range, 0.6-2.3). All of the patients survived. The 1- and 5-year graft survival rates were 93.3% and 86.7%, respectively.
The present study demonstrates the potential for successful outcomes of pediatric renal transplantation in this resource-limited area.
阐明孔敬府诗里拉（大学）医院儿童肾移植的人口统计学数据、结局及并发症。
作者回顾了2001年8月至2008年7月期间在孔敬府诗里拉医院接受肾移植的终末期肾病（ESRD）儿童的病历。
确定了8名男性和7名女性患者。他们的平均年龄为12.8±3.2岁（范围5.0 - 17.6岁）。ESRD的主要病因是肾脏先天性异常（53%）。所有儿童均接受尸体肾移植，无一例接受诱导治疗。12例患者使用了由环孢素、泼尼松龙和霉酚酸酯组成的三联免疫抑制药物。自2008年1月起，3例接受肾移植的患者使用他克莫司替代环孢素。中位随访时间为15个月（3至82个月）。最常见的并发症是尿路感染（40%）。1例患者（6.7%）因移植肾梗死出现急性移植肾丢失。其他并发症包括疱疹病毒感染、慢性排斥反应、急性排斥反应、严重牙龈增生、肌病、淋巴囊肿和膀胱移行细胞癌。2例患者分别因移植肾梗死和慢性排斥反应重新开始透析。其余病例最后一次随访时的平均血清肌酐为1.2±0.5mg/dL（范围0.6 - 2.3）。所有患者均存活。1年和5年移植肾存活率分别为93.3%和86.7%。
本研究表明在这个资源有限的地区儿童肾移植有取得成功结局的潜力。
