Considine S W, Davis N F, McLoughlin L C, Mohan P, Forde J C, Power R, Smyth G, Little D M
Department of Transplant Surgery and Urology, Beaumont Hospital, Dublin, Ireland.
Surgeon. 2019 Feb;17(1):1-5. doi: 10.1016/j.surge.2018.04.004. Epub 2018 May 25.
Transplant units are exploring strategies to increase the availability of donor kidneys. The use of en-bloc kidney transplantation (EBKT) from paediatric donors represents one potential solution. We present our long-term experience with paediatric EBKT among adult recipients.
Twenty-three paediatric to adult EBKTs were performed by the Irish National Kidney Transplant Service between 1990 and 2016. The primary outcome variable was long-term en-bloc allograft survival rate. Secondary outcome variables were incidence of allograft thrombosis, incidence of delayed graft function, overall patient survival and serum creatinine at most recent follow-up. Outcomes were compared to single kidney transplant recipients from the same time period.
Mean donor age was 1.8 ± 0.97 years (range: 7 months to 3 years). Recipient age was 46 ± 12 years. Mean follow-up was 133 ± 64 months (range: 36-264). Overall graft survival was 100%, 91% and 80% after 1, 5 and 10 years respectively, compared to 92%, 79% and 61% in single kidney transplant recipients (p = 0.04). There were 5 cases of allograft failure, 3 due to death from unrelated causes. Median time to graft failure was 108 months (range: 36-172). Mean serum creatinine was 72.6 ± 21.6 μmol/l after the follow-up period. There were no cases of graft thrombosis or delayed graft function. Overall survival was 96.4%, 88.0%, 76.23% and 50.5% at 1, 5, 10 and 20 years respectively.
En-bloc paediatric kidney transplantation is associated with excellent long-term allograft and patient survival and is a feasible strategy for increasing the transplant donor pool in carefully selected recipients.
移植单位正在探索增加供体肾脏可用性的策略。使用来自儿科供体的整块肾脏移植（EBKT）是一种潜在的解决方案。我们介绍了我们在成年受者中进行儿科EBKT的长期经验。
1990年至2016年间，爱尔兰国家肾脏移植服务中心进行了23例儿科到成人的EBKT。主要结局变量是整块同种异体移植物长期存活率。次要结局变量是移植物血栓形成的发生率、移植肾功能延迟的发生率、总体患者生存率以及最近一次随访时的血清肌酐水平。将结果与同一时期的单肾移植受者进行比较。
供体平均年龄为1.8±0.97岁（范围：7个月至3岁）。受者年龄为46±12岁。平均随访时间为133±64个月（范围：36 - 264个月）。1年、5年和10年后的总体移植物存活率分别为100%、91%和80%，而单肾移植受者分别为92%、79%和61%（p = 0.04）。有5例移植物失败，3例是由于无关原因死亡。移植物失败的中位时间为108个月（范围：36 - 172个月）。随访期后平均血清肌酐为72.6±21.6μmol/l。没有移植物血栓形成或移植肾功能延迟的病例。1年、5年、10年和20年的总体生存率分别为96.4%、88.0%、76.23%和50.5%。
整块儿科肾脏移植与优异的长期同种异体移植物和患者生存率相关，并且是在精心挑选的受者中增加移植供体库的可行策略。
