Rianthavorn Pornpimol, Kerr Stephen J, Lumpaopong Adisorn, Jiravuttipong Apichat, Pattaragarn Anirut, Tangnararatchakit Kanchana, Avihingsanon Yingyos, Thirakupt Prapaipim, Sumethkul Vasant
Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Pediatr Transplant. 2013 Mar;17(2):112-8. doi: 10.1111/petr.12047.
As universal coverage for pediatric kidney transplantation (KT) was introduced in Thailand in 2008, the number of recipients has been increasing. We evaluated predictive factors for graft failure to understand how to improve clinical outcomes in these children. Using data obtained from the National Transplant registry, we assessed the risk of graft failure using the Kaplan-Meier method and Cox proportional hazards regression. Altogether, 201 recipients aged <21 yr at the time of KT were studied. Living donors (LD) were significantly older than deceased donor (DD). Mean cold ischemia time of DD was 17 h. The mean donor glomerular filtration rate (GFR) was 84.0 mL/min/1.73 m(2) . Induction immunosuppressive therapy was administered more frequently in DD than in LDKT. Delayed graft function (DGF) occurred in 36 transplants. Over 719 person years of follow-up, 42 graft failures occurred. Graft survival at one, three, and five yr post-transplant were 95%, 88% and 76%, respectively. Two factors independently predicted graft failure in multivariate analysis. The hazard ratios for graft failure in patients with DGF and in patients with donor GFR of ≤30 mL/min/1.73 m(2) were 2.5 and 9.7, respectively. Pediatric recipients should receive the first priority for allografts from young DD with a good GFR, and DGF should be meticulously prevented.
2008年泰国引入了小儿肾移植（KT）的全民覆盖政策后，受者数量一直在增加。我们评估了移植失败的预测因素，以了解如何改善这些儿童的临床结局。利用从国家移植登记处获得的数据，我们采用Kaplan-Meier方法和Cox比例风险回归评估了移植失败的风险。总共研究了201名KT时年龄<21岁的受者。活体供者（LD）明显比尸体供者（DD）年龄大。DD的平均冷缺血时间为17小时。供者平均肾小球滤过率（GFR）为84.0 mL/min/1.73 m²。诱导免疫抑制治疗在DD中比在LD-KT中更频繁使用。36例移植发生了移植肾功能延迟恢复（DGF）。在超过719人年的随访中，发生了42例移植失败。移植后1年、3年和5年的移植肾存活率分别为95%、88%和76%。多因素分析中有两个因素独立预测移植失败。DGF患者和供者GFR≤30 mL/min/1.73 m²患者移植失败的风险比分别为2.5和9.7。小儿受者应优先接受来自年轻且GFR良好的DD的同种异体肾移植，并且应精心预防DGF。
