Beltrán S, Kanter J, Plaza A, Pastor T, Gavela E, Avila A, Sancho A, Crespo J, Pallardó L
Nephrology Department, Hospital Universitario Dr Peset, Valencia, Spain.
Transplant Proc. 2010 Oct;42(8):2841-4. doi: 10.1016/j.transproceed.2010.07.070.
The optimal use of kidneys from small pediatric cadaveric donors remains controversial. The aim of this study was to analyze short-term graft and patient survivals of en bloc kidney transplantations compared with single cadaveric adult donor kidney transplantations.
We compared the 1-year evolution of 14 adult recipients of en bloc pediatric kidney donors (EBKT) of median age 13.5±14.5 months (range=3 days to 48 months) with 182 recipients of ideal adult cadaveric donors (ADT) showing a median age of 30±21 years (range=14-45 years).
Besides the different age and weight of the donors, EBKT recipients were more commonly women (P=.05) and received thymoglobulin induction treatment (P=.00). Delayed graft function was higher in EBKT (46.2% vs 22.2%, P=.05), with no differences in the incidences of acute rejection episodes. Mean serum creatinine values at 3, 6, and 12 months after transplantation were 1.1±0.3, 1.1±0.2, and 1.0±0.2 mg/dL in the EBKT group, compared with 1.3±0.5 (P=.16), 1.3±0.5 (P=.02), and 1.3±0.6 (P<.01) in the ADT group. Vascular allograft complications were more frequent among EBKT. Graft survival rate at 1 year was 92% in both groups, with no differences in patient survival (100% in EBKT vs 92% in ADT; P=.49).
EBKT from small pediatric donors show excellent graft function and 1-year survival and should be considered for transplantation into adults.
小儿尸体小供肾的最佳利用仍存在争议。本研究旨在分析整块小儿肾移植与单个成人尸体供肾移植的短期移植物和患者存活率。
我们比较了14例整块小儿肾供体（EBKT）成人受者的1年病情发展情况，这些受者的年龄中位数为13.5±14.5个月（范围为3天至48个月），并与182例理想成人尸体供体（ADT）受者进行了比较，后者的年龄中位数为30±21岁（范围为14 - 45岁）。
除了供体的年龄和体重不同外，EBKT受者中女性更为常见（P = 0.05），且接受了抗胸腺细胞球蛋白诱导治疗（P = 0.00）。EBKT的移植肾功能延迟发生率更高（46.2%对22.2%，P = 0.05），急性排斥反应的发生率无差异。移植后3个月、6个月和12个月时，EBKT组的平均血清肌酐值分别为1.1±0.3、1.1±0.2和1.0±0.2mg/dL，而ADT组分别为1.3±0.5（P = 0.16）、1.3±0.5（P = 0.02）和1.3±0.6（P < 0.01）。EBKT中血管移植物并发症更为常见。两组1年时的移植物存活率均为92%，患者存活率无差异（EBKT为100%，ADT为92%；P = 0.49）。
来自小儿小供体的EBKT显示出良好的移植物功能和1年存活率，应考虑用于成人移植。
