Chinnakotla Srinath, Verghese Priya, Chavers Blanche, Rheault Michelle N, Kirchner Varvara, Dunn Ty, Kashtan Clifford, Nevins Thomas, Mauer Michael, Pruett Timothy
Department of Surgery, University of Minnesota Medical School and University of Minnesota Masonic Children's Hospital, Minneapolis, MN.
Department of Pediatrics, University of Minnesota Medical School and University of Minnesota Masonic Children's Hospital, Minneapolis, MN.
J Am Coll Surg. 2017 Apr;224(4):473-486. doi: 10.1016/j.jamcollsurg.2016.12.027. Epub 2017 Feb 27.
Advances in immunosuppression, surgical techniques, and management of infections in children receiving kidney transplants have affected outcomes.
We analyzed a prospectively maintained database of pediatric kidney transplantations.
From June 1963 through October 2016, we performed 1,056 pediatric kidney transplantations. Of these, 129 were in children less than 2 years old. The most common indications for transplant were congenital anomalies (dysplastic kidneys), obstructive uropathy, and congenital nephrotic syndrome. Living donors constituted 721 (68%) of all donors. The graft and patient survival rates remarkably improved for both deceased and living donor recipients (p = 0.001). Currently, graft survival rates for deceased donor recipients are 92% at 1 year, 76% at 5 years, and 57% at 10 years post-transplant; for living donor recipients, 96% at 1 year, 85% at 5 years, and 78% at 10 years. The graft half-life was 19 years in deceased donor recipients, compared with 25 years in living donor recipients (p ≤ 0.001). Acute rejection was the most common cause of graft loss in the first year post-transplant. The following risk factors were associated with an increased risk of graft loss: deceased donor grafts (p = 0.0001), retransplant (p = 0.02), ages 11 to 18 years (p = 0.001) and pre-transplant urologic issues (p = 0.04). Living donor grafts (p ≤ 0.0001) and pre-emptive transplants (p = 0.02) were associated with decreased risks of graft loss.
The success rates of pediatric kidney transplants have significantly improved. Pre-emptive kidney transplantation with a living donor graft continues to be superior and should be the choice in children with end-stage renal disease.
免疫抑制、手术技术以及肾移植儿童感染管理方面的进展已影响到治疗结果。
我们分析了一个前瞻性维护的儿科肾移植数据库。
从1963年6月至2016年10月，我们进行了1056例儿科肾移植手术。其中，129例是针对2岁以下儿童。最常见的移植适应证是先天性异常（发育不良性肾脏）、梗阻性尿路病和先天性肾病综合征。活体供者占所有供者的721例（68%）。对于尸体供者和活体供者受者，移植物和患者存活率均显著提高（p = 0.001）。目前，尸体供者受者移植后1年的移植物存活率为92%，5年为76%，10年为57%；活体供者受者移植后1年为96%，5年为85%，10年为78%。尸体供者受者的移植物半衰期为19年，而活体供者受者为25年（p≤0.001）。急性排斥是移植后第一年移植物丢失的最常见原因。以下危险因素与移植物丢失风险增加相关：尸体供者移植物（p = 0.0001）、再次移植（p = 0.02）、11至18岁（p = 0.001）以及移植前泌尿系统问题（p = 0.04）。活体供者移植物（p≤0.0001）和抢先移植（p = 0.02）与移植物丢失风险降低相关。
儿科肾移植的成功率已显著提高。活体供者移植物的抢先肾移植仍然更具优势，应成为终末期肾病儿童的首选。
