Clinical Pharmacy, AL-Isra University, Amman, Jordan.
Pediatr Neonatol. 2012 Feb;53(1):24-33. doi: 10.1016/j.pedneo.2011.11.006. Epub 2012 Feb 4.
Recently, many international studies have suggested that pediatric patients from diverse ethnic origins confront unique challenges for transplantation. Data concerning the efficacy and safety of transplantation for various pediatric renal transplant populations remains limited and are often confounded by immunosuppressive protocols. In one study, we aimed to evaluate the short- and long-term outcomes of renal transplants in Jordanian children in comparison with groups of different nationalities.
We retrospectively retrieved data for 34 Jordanian children who received kidney transplants from living donors between January 2003 and January 2009. Subsequently, we continued to follow-up with these selected patients at scheduled clinic visits to prospectively collect long-term data for a period of approximately 22 months±15 months.
The patients included in this study ranged between 4 years and 19 years of age. The male/female ratio was 0.79. Glumerulonephritis (35.3%) was the most common cause of end-stage renal disease in the sample of this study; 23.5% had received a preemptive transplant. All patients also received triple immunosuppressive therapy, consisting of tacrolimus (TAC), prednisolone, and mycophenolate mofetil (n=26) or azathioprine (n=8). Furthermore, the rate of acute rejection episodes was lower in the sample of this study than the average rate of many previous studies. The patients' survival rate at 1 year, 2 years and 3 years posttransplant was nearly 100%. The corresponding graft survivals were 97.1%, 94.12% and 91.2% respectively. Beyond three years, one female patient died postgraft loss. This graft loss was mainly attributed to recurrent glomerulonephritis. Strikingly, the prevalence of posttransplant diabetes (PTD) and hypertension was higher than reported international figures. Other adverse events, such as infections, were manageable.
The average result of pediatric renal transplantation in Jordan is more successful than the average results of this procedure in many developed countries, especially in terms of early graft function, acute rejection episodes as well as long-term patient and graft survivals. However, additional studies are needed to better characterize pharmacokinetic of TAC and to fully understand those factors that lead to an increased probability of developing conditions like PTD and hypertension.
最近，许多国际研究表明，来自不同种族起源的儿科患者在移植方面面临独特的挑战。关于各种儿科肾移植人群的移植效果和安全性的数据仍然有限，并且经常受到免疫抑制方案的混淆。在一项研究中，我们旨在评估约旦儿童肾移植的短期和长期结果，并与不同国籍的群体进行比较。
我们回顾性地检索了 2003 年 1 月至 2009 年 1 月期间从活体供者接受肾移植的 34 名约旦儿童的数据。随后，我们继续在预定的门诊就诊中对这些选定的患者进行随访，前瞻性地收集大约 22 个月±15 个月的长期数据。
本研究中的患者年龄在 4 岁至 19 岁之间。男女比例为 0.79。肾小球肾炎（35.3%）是本研究样本中终末期肾病的最常见原因；23.5%的患者接受了预防性移植。所有患者还接受了三联免疫抑制治疗，包括他克莫司（TAC）、泼尼松和霉酚酸酯（n=26）或硫唑嘌呤（n=8）。此外，本研究中急性排斥反应的发生率低于许多先前研究的平均水平。移植后 1 年、2 年和 3 年的患者生存率接近 100%。相应的移植物存活率分别为 97.1%、94.12%和 91.2%。超过 3 年，一名女性患者在移植后丧失移植物后死亡。这种移植物丢失主要归因于复发性肾小球肾炎。值得注意的是，移植后糖尿病（PTD）和高血压的患病率高于国际报道的数字。其他不良事件，如感染，是可以控制的。
约旦儿科肾移植的平均结果优于许多发达国家的这一手术的平均结果，尤其是在早期移植物功能、急性排斥反应以及长期患者和移植物存活率方面。然而，需要进一步的研究来更好地描述 TAC 的药代动力学，并充分了解导致 PTD 和高血压等疾病发生概率增加的因素。
