Section of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.
Division of Pediatric Nephrology, Hypertension and Pheresis, Department of Pediatrics, Washington University School of Medicine, Saint Louis, Missouri, USA.
Pediatr Transplant. 2022 Feb;26(1):e14149. doi: 10.1111/petr.14149. Epub 2021 Sep 28.
Pediatric sHKTx remains uncommon in the US. We examined outcomes of pediatric sHKTx compared to PHTx alone. Our objective was to identify a threshold eGFR that justified pediatric sHKTx.
Data from the SRTR heart and kidney databases were used to identify 9245 PHTx, and 63 pediatric sHKTx performed between 1992 and 2017 (age ≤21 years).
The median age for sHKTx was 16 years, and included 31 males (31/63 = 49%). Over half of sHKTx (36/63 = 57%) were performed in cases where pretransplant dialysis was initiated. Among patients who required pretransplant dialysis, the risk of death in sHKTx recipients was significantly lower than PHTx alone (sHKTx vs. PHTx: HR 0.4, 95% CI [0.2, 0.9], p = .01). In those without pretransplant dialysis, there was no improvement in survival between sHKTx and PHTx (p = .2). When stratified by eGFR, PHTx alone recipients had worse survival than sHKTx in the group with eGFR ≤35 ml/min/1.73 m (p = .04). The 1- and 5-year actuarial survival rates in pediatric sHKTx recipients were 87% and 81.5% respectively and was similar to isolated PHTx (p = .5). One-year rates of treated heart (11%) and kidney (7.9%) rejection were similar in sHKTx compared to PHTx alone (p = .7) and pediatric kidney transplant alone (p = .5) respectively.
Pediatric sHKTx should be considered in HTx candidates with kidney failure requiring dialysis or eGFR ≤35 ml/min/1.73 m . The utility of sHKTx in cases of kidney failure not requiring dialysis warrants further study.
在美国，儿科患者接受单器官心脏移植（sHKTx）的情况仍较为少见。我们对接受 sHKTx 的儿科患者与单独接受心脏移植（PHTx）的患者的结局进行了比较。我们的目的是确定一个 eGFR 阈值，以证明儿科 sHKTx 的合理性。
我们使用 SRTR 心脏和肾脏数据库中的数据，确定了 1992 年至 2017 年间接受 9245 例 PHTx 和 63 例儿科 sHKTx 的患者。
sHKTx 的中位年龄为 16 岁，其中 31 例（31/63=49%）为男性。超过一半的 sHKTx（36/63=57%）是在开始移植前透析的情况下进行的。在需要移植前透析的患者中，sHKTx 受者的死亡风险明显低于单独接受 PHTx（sHKTx 与 PHTx：HR 0.4，95%CI [0.2，0.9]，p=0.01）。在未接受移植前透析的患者中，sHKTx 与 PHTx 之间的生存率无明显改善（p=0.2）。按 eGFR 分层后，在 eGFR≤35ml/min/1.73m2 的患者中，单独接受 PHTx 的患者生存率差于 sHKTx（p=0.04）。儿科 sHKTx 受者的 1 年和 5 年实际生存率分别为 87%和 81.5%，与单独接受 PHTx 相似（p=0.5）。sHKTx 与单独接受 PHTx（p=0.7）和单独接受儿科肾移植（p=0.5）相比，1 年心脏（11%）和肾脏（7.9%）排斥的治疗率相似。
对于需要透析或 eGFR≤35ml/min/1.73m2 的肾衰竭的 HTx 候选者，应考虑儿科 sHKTx。对于不需要透析的肾衰竭患者，sHKTx 的应用价值尚需进一步研究。
