Boehm Michael, Bonthuis Marjolein, Aufricht Christoph, Battelino Nina, Bjerre Anna, Edvardsson Vidar O, Herthelius Maria, Hubmann Holger, Jahnukainen Timo, de Jong Huib, Laube Guido F, Mattozzi Francesca, Molchanova Elena A, Muñoz Marina, Noyan Aytul, Pape Lars, Printza Nikoleta, Reusz George, Roussey Gwenaelle, Rubik Jacek, Spasojevic'-Dimitrijeva Brankica, Seeman Tomas, Ware Nicholas, Vidal Enrico, Harambat Jérôme, Jager Kitty J, Groothoff Jaap
Division of Pediatric Nephrology and Gastroenterology, Medical University of Vienna, Vienna, Austria.
ESPN/ERA-EDTA Registry, Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Transplantation. 2022 Mar 1;106(3):607-614. doi: 10.1097/TP.0000000000003771.
Many centers accept a minimum body weight of 10 kg as threshold for kidney transplantation (Tx) in children. As solid evidence for clinical outcomes in multinational studies is lacking, we evaluated practices and outcomes in European children weighing below 10 kg at Tx.
Data were obtained from the European Society of Paediatric Nephrology/European Renal Association and European Dialysis and Transplant Association Registry on all children who started kidney replacement therapy at <2.5 y of age and received a Tx between 2000 and 2016. Weight at Tx was categorized (<10 versus ≥10 kg) and Cox regression analysis was used to evaluate its association with graft survival.
One hundred of the 601 children received a Tx below a weight of 10 kg during the study period. Primary renal disease groups were equal, but Tx <10 kg patients had lower pre-Tx weight gain per year (0.2 versus 2.1 kg; P < 0.001) and had a higher preemptive Tx rate (23% versus 7%; P < 0.001). No differences were found for posttransplant estimated glomerular filtration rates trajectories (P = 0.23). The graft failure risk was higher in Tx <10 kg patients at 1 y (graft survival: 90% versus 95%; hazard ratio, 3.84; 95% confidence interval, 1.24-11.84), but not at 5 y (hazard ratio, 1.71; 95% confidence interval, 0.68-4.30).
Despite a lower 1-y graft survival rate, graft function, and survival at 5 y were identical in Tx <10 kg patients when compared with Tx ≥10 kg patients. Our results suggest that early transplantation should be offered to a carefully selected group of patients weighing <10 kg.
许多中心将最低体重10千克作为儿童肾移植（Tx）的阈值。由于缺乏跨国研究中临床结果的确凿证据，我们评估了欧洲体重低于10千克的儿童肾移植的实际情况和结果。
数据来自欧洲儿科肾脏病学会/欧洲肾脏协会以及欧洲透析与移植协会登记处，涵盖所有在2.5岁之前开始肾脏替代治疗并于2000年至2016年间接受肾移植的儿童。肾移植时的体重分为两类（<10千克与≥10千克），并采用Cox回归分析评估其与移植物存活的关联。
在研究期间，601名儿童中有100名在体重低于10千克时接受了肾移植。原发性肾脏疾病组相同，但体重<10千克的肾移植患者移植前每年体重增加较低（0.2千克对2.1千克；P<0.001），且抢先肾移植率较高（23%对7%；P<0.001）。移植后估计肾小球滤过率轨迹无差异（P=0.23）。体重<10千克的肾移植患者在1年时移植物失败风险较高（移植物存活率：90%对95%；风险比，3.84；95%置信区间，1.24 - 11.84），但在5年时无差异（风险比，1.71；95%置信区间，0.68 - 4.30）。
尽管体重<10千克的肾移植患者1年移植物存活率较低，但与体重≥10千克的肾移植患者相比，其5年时的移植物功能和存活率相同。我们的结果表明，应向精心挑选的体重<10千克的患者群体提供早期移植。
