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小儿肾移植后的泌尿系统并发症、膀胱输尿管反流及长期移植肾存活率

Urological complications, vesicoureteral reflux, and long-term graft survival rate after pediatric kidney transplantation.

作者信息

Torricelli Fabio C M, Watanabe Andreia, Piovesan Affonso C, Antonopoulos Ioannis M, David-Neto Elias, Nahas William C

机构信息

Division of Urology, University of Sao Paulo Medical School, Sao Paulo, Brazil.

Department of Pediatrics, University of Sao Paulo Medical School, Sao Paulo, Brazil.

出版信息

Pediatr Transplant. 2015 Dec;19(8):844-8. doi: 10.1111/petr.12591. Epub 2015 Oct 3.

Abstract

To describe a single-center experience with kidney transplantation and then study some donor and recipient features that may impact on graft survival and urological complication rates. We reviewed our database searching for pediatric patients who underwent kidney transplantation from August 1985 through November 2012. Preoperative data and postoperative complications were recorded. Graft survival rates were analyzed and compared based on the type of donor, donor's age from deceased donors, and recipients' ESRD cause. Kaplan-Meier curves with log rank and Wilcoxon tests were used to perform the comparisons. There were 305 pediatric kidney transplants. The mean recipient's age was 11.7 yr. The mean follow-up was 11.0 yr. Arterial and venous thrombosis rates were 1.6% and 2.3%, respectively, while urinary fistula and symptomatic vesicoureteral reflux were diagnosed in 2.9% and 3.6% of cases, respectively. Deceased kidney transplantation had a lower graft survival rate than living kidney transplantation (log rank, p = 0.005). Donor's age (p = 0.420) and ESRD cause (p = 0.679) were not significantly related to graft survival rate. In long-term follow-up, type of donor, but not donor's age, impacts on graft survival rate. ESRD cause has no impact on graft survival rate, showing that well-evaluated recipients may have good outcomes.

摘要

描述单中心肾移植经验,然后研究一些可能影响移植肾存活及泌尿系统并发症发生率的供体和受体特征。我们检索数据库,查找1985年8月至2012年11月期间接受肾移植的儿科患者。记录术前数据和术后并发症。根据供体类型、已故供体的年龄以及受体的终末期肾病病因分析并比较移植肾存活率。采用带有对数秩检验和Wilcoxon检验的Kaplan-Meier曲线进行比较。共有305例儿科肾移植。受体的平均年龄为11.7岁。平均随访时间为11.0年。动脉和静脉血栓形成率分别为1.6%和2.3%,而尿瘘和有症状的膀胱输尿管反流分别在2.9%和3.6%的病例中被诊断出来。已故供体肾移植的移植肾存活率低于活体供体肾移植(对数秩检验,p = 0.005)。供体年龄(p = 0.420)和终末期肾病病因(p = 0.679)与移植肾存活率无显著相关性。在长期随访中,供体类型而非供体年龄影响移植肾存活率。终末期肾病病因对移植肾存活率无影响,表明经过充分评估的受体可能有良好预后。

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