Ginevri Fabrizio, Dello Strologo Luca, Guzzo Isabella, Belingheri Mirco, Ghio Luciana
Medicina Clinica e Sperimentale dei Trapianti, U.O.C. Nefrologia, Istituto G. Gaslini, Genova, Italy.
G Ital Nefrol. 2011 Jan-Feb;28(1):15-25.
A living-donor kidney transplant offers a child at the terminal stages of renal disease better functional recovery and quality of life than an organ from a deceased donor. Before starting the procedure for a living-donor transplant, however, it is necessary to establish if it is really safe. There are diseases, such as focal segmental glomerulosclerosis, atypical HUS and membranoproliferative glomerulonephritis with dense deposits, for which living donation is not recommended given the high incidence of recurrence of the disease but also the frequent loss of the graft. Regarding the selection of the donor, an increased risk of acute rejection has been reported for donors older than 60-65 years and a worsening of the renal outcome if the donor's weight is equal to or less than the recipient's. Finally, it is necessary to take into consideration that complications may arise in the donor both in the perioperative period and in the long term. In conclusion, kidney transplant from a living donor is a natural choice within the pediatric setting. The parents, usually young and highly motivated to donate, are the ideal donors. However, although the risks associated with donation are minimal, they are not totally absent, and consequently it is mandatory to follow standardized procedures according to the guidelines issued by the Centro Nazionale Trapianti.
与来自已故捐赠者的器官相比，活体捐赠者肾移植能让处于终末期肾病的儿童获得更好的功能恢复和生活质量。然而，在开始活体捐赠者移植手术之前，有必要确定其是否真的安全。对于某些疾病，如局灶节段性肾小球硬化症、非典型溶血尿毒综合征以及伴有致密沉积物的膜增生性肾小球肾炎，鉴于疾病复发率高且移植肾频繁丢失，不建议进行活体捐赠。关于捐赠者的选择，据报道60 - 65岁以上的捐赠者急性排斥反应风险增加，且如果捐赠者体重等于或小于受者体重，肾脏结局会恶化。最后，有必要考虑到捐赠者在围手术期和长期都可能出现并发症。总之，活体捐赠者肾移植在儿科领域是一种自然的选择。父母通常年轻且极有捐赠意愿，是理想的捐赠者。然而，尽管与捐赠相关的风险极小，但并非完全不存在，因此必须按照国家移植中心发布的指南遵循标准化程序。
