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[肾移植:医疗难民面临的机遇与风险]

[Renal transplantation: Opportunities and risks for medical refugees].

作者信息

Mammadova D, Hirsch K, Schwaiger B, Wullich B, Rascher W

机构信息

Kinder- und Jugendklinik, Friedrich-Alexander Universität Erlangen-Nürnberg, Loschgestr. 15, 91054, Erlangen, Deutschland.

Urologische und Kinderurologische Klinik, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, 91054, Deutschland.

出版信息

Urologe A. 2018 Oct;57(10):1200-1207. doi: 10.1007/s00120-018-0759-3.

Abstract

BACKGROUND

Families with children and adolescents with end-stage renal disease came to Germany from the former Eastern Bloc countries before the wave of refugees in 2015, in order to enable their children to survive with adequate kidney replacement therapy and in the best case a kidney transplant.

METHODS

In a case study, medical records of 4 childen and adolescents were retrospectively analyzed. These patients who fled to Germany for the treatment of terminal renal failure applied for asylum and were successfully transplanted after the usual waiting period.

RESULTS

Four of the eight children and adolescents who came to Erlangen for treatment of terminal renal failure between 2003 and 2013 received a functioning kidney transplant (deceased donor kidney) after dialysis therapy was difficult due to lack of compliance to drug and dietary recommendations such as fluid restriction. Since children and adolescents are treated with chronic dialysis only with the aim of kidney transplantation, a living donation was discussed but was not possible for medical reasons. 3 recipients are symptom-free with a functional graft.

DISCUSSION

The case study demonstrates that children and adolescents fleeing to Germany due to their end stage renal disease are better integrated after kidney transplantation, have better chances of obtaining a good education and can be expected to live independently with their own income in the future.

摘要

背景

在2015年难民潮之前,患有终末期肾病的儿童和青少年家庭从前东欧国家来到德国,以便他们的孩子能够通过适当的肾脏替代疗法生存,最好是接受肾脏移植。

方法

在一项案例研究中,对4名儿童和青少年的病历进行了回顾性分析。这些因终末期肾衰竭逃到德国接受治疗的患者申请了庇护,并在经过通常的等待期后成功接受了移植。

结果

2003年至2013年间来到埃尔朗根接受终末期肾衰竭治疗的8名儿童和青少年中,有4名在因不遵守药物和饮食建议(如液体限制)导致透析治疗困难后,接受了功能正常的肾脏移植(已故捐赠者的肾脏)。由于儿童和青少年接受慢性透析仅仅是为了进行肾脏移植,因此曾讨论过活体捐赠,但由于医学原因未能实现。3名受者移植后无症状,移植肾功能良好。

讨论

该案例研究表明,因终末期肾病逃到德国的儿童和青少年在接受肾脏移植后能更好地融入社会,有更好的机会接受良好的教育,并且有望在未来依靠自己的收入独立生活。

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