Choi J Y, Jung J H, Kwon J G, Shin S, Kim Y H, Jang H J, Han D J
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Surgery, Gangneung Hospital, University of Ulsan College of Medicine, Seoul, Korea.
Transplant Proc. 2017 Jun;49(5):977-981. doi: 10.1016/j.transproceed.2017.03.028.
To overcome a shortage of donors, cadaveric pediatric en bloc kidneys can be used to expand the donor pool. Recent evidence shows that en bloc kidney transplantation (EBKT) has better outcomes than standard-criteria deceased adult donor kidney transplantation. We reviewed our experiences of EBKT and their outcomes.
From September 1996 to January 2016, 15 EBKTs were performed in Asan Medical Center. The characteristics of donors and recipients were analyzed. Graft survival was analyzed by means of serum creatinine levels.
Nine male and 6 female donors were used. The mean age and body weight of donors was 2.79 years (range, 0.25-14) and 13.14 kg (range, 5.5-35). The mean weight of en bloc kidneys was 117.43 g (range, 36-146). Recipient median age was 39.13 years and body weight was 49.47 kg. Ureteral anastomosis was performed by means of side-to-side anastomosis and then bladder anastomosis in 9 patients and by bladder patch anastomosis in 4 patients. Serum creatinine levels at discharge and latest follow-up were 0.97 mg/dL (range, 0.7-1.54) and 0.89 mg/dL (range, 0.44-2.58). Delayed graft function developed in 3 patients and clinical rejection developed in 2 patients. We performed graftectomy on post-operative day 1 because of graft thrombosis. The rest maintained their graft function well. Graft survival was comparable with that of kidney transplantation from standard donors.
EBKT showed excellent graft function and outcomes at our center. As an approach to expand the donor pool and improve graft utilization, EBKT is acceptable and should be more widely used.
为克服供体短缺问题，可使用尸体小儿整块肾脏来扩大供体库。近期证据表明，整块肾脏移植（EBKT）的效果优于标准标准已故成人供体肾脏移植。我们回顾了我们的EBKT经验及其结果。
1996年9月至2016年1月，在峨山医学中心进行了15例EBKT。分析了供体和受体的特征。通过血清肌酐水平分析移植物存活情况。
使用了9名男性和6名女性供体。供体的平均年龄和体重分别为2.79岁（范围0.25 - 14岁）和13.14千克（范围5.5 - 35千克）。整块肾脏的平均重量为117.43克（范围36 - 146克）。受体中位年龄为39.13岁，体重为49.47千克。9例患者采用端端吻合然后膀胱吻合进行输尿管吻合，4例患者采用膀胱补片吻合。出院时和最新随访时的血清肌酐水平分别为0.97毫克/分升（范围0.7 - 1.54）和0.89毫克/分升（范围0.44 - 2.58）。3例患者发生移植肾功能延迟恢复，2例患者发生临床排斥反应。1例患者因移植肾血栓形成在术后第1天进行了移植肾切除术。其余患者移植肾功能维持良好。移植物存活率与标准供体肾脏移植相当。
在我们中心，EBKT显示出优异的移植肾功能和结果。作为一种扩大供体库和提高移植物利用率的方法，EBKT是可接受的，应更广泛地应用。
