Huang Mingchuan, Wu Wenrui, Zhang Qiang, Li Jun, Zhang Huanxi, Wu Chenglin, Fu Qian, Wu Shenghui, Chen Yanxu, Li Jianming, Su Xiaojun, Liu Longshan, Wang Changxi
Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.
Transl Pediatr. 2022 Nov;11(11):1872-1885. doi: 10.21037/tp-22-547.
Pediatric deceased donors offer great potential for expanding the organ donor pool. The utilization of pediatric donor kidneys has been explored by numerous transplant centers; however, the transplant outcome and risk factors have not been well elucidated. The aim of this study was to demonstrate the safety and risk factors of transplant outcome from pediatric deceased donors.
We retrospectively analyzed 484 cases of single kidney transplantation (SKT) with pediatric donor kidneys performed at our center from January 2012 to March 2021. The recipients were grouped by age: child (≤12 years; n=143), adolescents (12-18 years; n=86), and adults (≥18 years; n=255). The overall prognosis of the recipients was analyzed, and the post-transplant outcomes were compared among the three groups and assessed by univariate and multivariate analyses using the Cox proportional risk model.
The median follow-up time was 26.7 months. The 1- and 3-year patient survival rates were 98.7% and 96.8%, respectively. The 1- and 3-year death-censored graft survival (DCGS) was 96.1% and 92.7%, respectively. The overall estimated glomerular filtration rates (eGFRs) at 1 and 3 years were 80.0±24.5 and 84.2±25.2 mL/min/1.73 m; the 3-year eGFR of the three groups were comparable and all were over 80 mL/min/1.73 m. Rejection was an independent risk factor for death-censored graft failure within 3 years after transplantation [hazard ratio (HR) =3.85; P=0.001], and was the primary cause of graft losses in the adolescent group. Thrombosis was more common within 1-month post-transplant in the child recipients (P<0.05), and its incidence was higher in recipients with donor body weight (DBW) ≤11 kg.
SKT from pediatric donors could achieve decent outcomes. Rejection was an independent risk factor of graft survival, especially for adolescent recipients. Child recipients may compromise early transplant outcomes due to vascular thrombosis, which might be related to small (DBW ≤11 kg) pediatric donors.
儿科死亡供体为扩大器官供体库提供了巨大潜力。众多移植中心已对儿科供体肾脏的利用进行了探索；然而，移植结果及危险因素尚未得到充分阐明。本研究的目的是阐明儿科死亡供体移植结果的安全性及危险因素。
我们回顾性分析了2012年1月至2021年3月在本中心进行的484例儿科供体肾脏单肾移植（SKT）病例。受者按年龄分组：儿童（≤12岁；n = 143）、青少年（12 - 18岁；n = 86）和成人（≥18岁；n = 255）。分析了受者的总体预后情况，并对三组受者的移植后结果进行比较，采用Cox比例风险模型进行单因素和多因素分析评估。
中位随访时间为26.7个月。1年和3年的患者生存率分别为98.7%和96.8%。1年和3年的死亡删失移植物生存率（DCGS）分别为96.1%和92.7%。1年和3年时的总体估计肾小球滤过率（eGFR）分别为80.0±24.5和84.2±25.2 mL/min/1.73 m²；三组的3年eGFR具有可比性，均超过80 mL/min/1.73 m²。排斥反应是移植后3年内死亡删失移植物失败的独立危险因素[风险比（HR）= 3.85；P = 0.001]，且是青少年组移植物丢失的主要原因。血栓形成在儿童受者移植后1个月内更为常见（P < 0.05），且在供体体重（DBW）≤11 kg的受者中发生率更高。
儿科供体的SKT可取得良好结果。排斥反应是移植物存活的独立危险因素，尤其是对青少年受者而言。儿童受者可能因血管血栓形成而影响早期移植结果，这可能与体型较小（DBW≤11 kg）的儿科供体有关。
