Hayes Wesley, Longley Catherine, Scanlon Nicola, Bryant William, Stojanovic Jelena, Kessaris Nicos, Van't Hoff William, Bockenhauer Detlef, Marks Stephen D
Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.
University College London Great Ormond Street Institute of Child Health, London, UK.
Pediatr Transplant. 2019 Jun;23(4):e13411. doi: 10.1111/petr.13411. Epub 2019 Apr 11.
In current practice, pediatric kidney transplant recipients receive large volumes of intravenous fluid intraoperatively to establish allograft perfusion, and further fluid to replace urinary and insensible losses postoperatively. Acute electrolyte imbalance can result, with potential for neurological sequelae. We aimed to determine the incidence and severity of postoperative plasma electrolyte imbalance in pediatric kidney transplant recipients managed with the current standard intravenous crystalloid regimen.
A retrospective analysis of plasma electrolytes in the first 72 hours post-kidney transplant in 76 children transplanted between January 1, 2015, and January 31, 2018, managed with a standard intravenous fluid strategy used in most UK pediatric transplant centers.
Of 76 pediatric transplant recipients of median age 9.9 (range 2.2-17.9) years predominantly managed with 0.45% sodium chloride 5% glucose, 45 (59%) developed acute hyponatremia, 23 (30%) hyperkalemia, and 43 (57%) non-anion-gap acidosis in the postoperative period. Hyperglycemia occurred in 74 (97%) patients. Hyperkalemia was more prevalent in deceased than live donor recipients (P = 0.003) and was significantly associated with non-anion-gap acidosis (P < 0.001). Recipient weight was not associated with overt electrolyte imbalance.
Postoperative plasma electrolyte imbalance is common in pediatric kidney transplant recipients. Current clinical care strategies mitigate the associated risks of neurological sequelae to some degree. Further studies to optimize intravenous fluid therapy and minimize electrolyte disturbance in this group of patients are needed.
在当前的临床实践中，小儿肾移植受者在术中接受大量静脉输液以建立移植肾灌注，并在术后补充更多液体以替代尿液和不显性失水。这可能导致急性电解质失衡，并有可能引发神经后遗症。我们旨在确定采用当前标准静脉晶体液方案治疗的小儿肾移植受者术后血浆电解质失衡的发生率和严重程度。
对2015年1月1日至2018年1月31日期间接受肾移植的76名儿童术后72小时内的血浆电解质进行回顾性分析，这些儿童采用了英国大多数儿科移植中心使用的标准静脉输液策略。
76名小儿移植受者的中位年龄为9.9岁（范围2.2 - 17.9岁），主要接受0.45%氯化钠加5%葡萄糖治疗，其中45名（59%）在术后出现急性低钠血症，23名（30%）出现高钾血症，43名（57%）出现非阴离子间隙性酸中毒。74名（97%）患者出现高血糖。高钾血症在已故供体受者中比活体供体受者更常见（P = 0.003），并且与非阴离子间隙性酸中毒显著相关（P < 0.001）。受者体重与明显的电解质失衡无关。
小儿肾移植受者术后血浆电解质失衡很常见。当前的临床护理策略在一定程度上降低了神经后遗症的相关风险。需要进一步研究以优化这组患者的静脉输液治疗并尽量减少电解质紊乱。
