Pediatric Kidney Transplantation, Hospital Samaritano de São Paulo, Brazil.
Pediatric Department of Federal University of São Paulo - UNIFESP, Brazil.
Transplantation. 2020 Mar;104(3):591-596. doi: 10.1097/TP.0000000000002807.
Small children are less frequently transplanted when compared with older. The objective of the present study was to compare the preparation time for transplantation in children of different weights and to identify factors associated with a delay in the workup of small children.
We report on a retrospective cohort comprising all children referred for renal transplantation (RTx) workup between 2009 and 2017. The main outcome was transplantation workup time, defined as the time elapsed between the first consultation and when the child became ready for the surgery.
A total of 389 children (63.5% males) were selected, with a median weight of 18 kg (interquartile range, 11-32). Patients were categorized into 2 groups: group A (study group): ≤15 kg (n = 165) and group B (control group): >15 kg (n = 224). The probability of being ready for RTx was comparable between groups A and B. The cumulative incidence rate difference between groups is -0.05 (95% confidence interval, -0.03 to 0.02). The median time for RTx workup was 5.4 (2.4-9.4) in group A and 4.3 (2.2-9.0) months in group B (P = 0.451). Moreover, the presence of urinary tract malformation was associated with the need for longer transplantation workup time (P < 0.001).
In children >7 kg, the workup time for transplantation is not related to body weight. In a specialized center, children weighing 7-15 kg became ready within the same timeframe as children weighing >15 kg, despite the smaller children had greater difficulty being nourished, dialyzed, and a greater need for surgical correction of the urinary tract pretransplant.
与年龄较大的儿童相比，较小的儿童接受移植的频率较低。本研究的目的是比较不同体重儿童的移植准备时间，并确定与儿童准备时间延迟相关的因素。
我们报告了一项回顾性队列研究，该研究纳入了 2009 年至 2017 年间所有接受肾移植（RTx）检查的儿童。主要结局是移植检查时间，定义为从第一次就诊到儿童准备好手术的时间间隔。
共选择了 389 名儿童（63.5%为男性），体重中位数为 18 公斤（四分位距，11-32）。患者分为 2 组：A 组（研究组）：≤15 公斤（n=165）和 B 组（对照组）：>15 公斤（n=224）。A 组和 B 组准备接受 RTx 的可能性相似。组间累积发生率差异为-0.05（95%置信区间，-0.03 至 0.02）。A 组 RTx 检查的中位时间为 5.4（2.4-9.4）个月，B 组为 4.3（2.2-9.0）个月（P=0.451）。此外，尿路畸形的存在与需要更长的移植准备时间相关（P<0.001）。
在体重>7 公斤的儿童中，移植准备时间与体重无关。在专门中心，体重 7-15 公斤的儿童与体重>15 公斤的儿童在同一时间段内准备就绪，尽管较小的儿童在喂养、透析方面困难更大，并且在移植前更需要手术矫正泌尿道。
