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[婴儿肾移植的疗效与预后]

[Efficacy and prognosis of infant kidney transplantation].

作者信息

Zhu L, Guo Z L, Zhao D D, Sa R L, Zhao G Y, Zhang Y, Qiu L R, Zhou J H, Li W J, Guo H, Shen Y Y, Li X Z, Chen Z S, Chen G

机构信息

Institute of Organ Transplantation, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China The Key Laboratory of Organ Transplantation, the Ministry of Education, the Key Laboratory of Organ Transplantation, National Health Commission, the Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan 430030, China.

Institute of Organ Transplantation, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2023 Oct 17;103(38):3010-3016. doi: 10.3760/cma.j.cn112137-20230306-00338.

Abstract

To analyze the effect and prognosis of infant kidney transplantation. Clinical data of 37 cases of infant kidney transplantation under 3 years old in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from June 1, 2017 to July 31, 2022 were retrospectively collected. These 37 cases included 31 primary kidney transplantation and 6 secondary kidney transplantation. Kaplan-Meier method was used to draw the survival curve of the transplanted kidney and the recipient, and the prognosis and complications were analyzed. Median follow-up was 18 months (range: 6-66 months). The recipients were 20 males and 17 females, with a median age of 16 months (range: 2 months, 26 days to 36 months) and a median weight of 8 kg (range: 3.2 to 14.0 kg). The youngest child was only 2 months, 26 days old, and weighed only 3.2 kg. The most common primary disease of recipients was congenital nephrotic syndrome (13 cases, 41.9%). Intra-abdominal transplantation occurred in 19 cases (51.3%) and intra-iliac fossa transplantation occurred in the remaining 18 cases (48.6%). Postoperative renal function recovery was delayed in 7 cases (18.9%), and thrombosis caused renal function loss in 5 cases (13.5%), of which 4 cases received second renal transplantation and were successful. During the follow-up period, there were 11 cases of acute rejection (29.7%) and 6 cases of CMV pneumonia (16.2%). The estimated glomerular filtration rate 1 year after transplantation was higher than that 1 month after surgery [(101.9±22.1) vs (71.1±25.6) ml/(min·1.73m), <0.001], and remained constant 2 years after transplantation. Both the 1-year and 2-year survival rates of the transplanted kidney were 85.3%, and both the 1-year and 2-year survival rates of the recipients were 96.8%. Although the implementation of infant kidney transplantation is difficult, it can still achieve relatively satisfactory efficacy and prognosis.

摘要

分析婴幼儿肾移植的疗效及预后。回顾性收集2017年6月1日至2022年7月31日在华中科技大学同济医学院附属同济医院进行的37例3岁以下婴幼儿肾移植的临床资料。这37例中包括31例初次肾移植和6例再次肾移植。采用Kaplan-Meier法绘制移植肾及受者的生存曲线,并分析预后及并发症。中位随访时间为18个月(范围:6 - 66个月)。受者中男性20例,女性17例,中位年龄为16个月(范围:2个月26天至36个月),中位体重为8 kg(范围:3.2至14.0 kg)。最小的患儿仅2个月26天,体重仅3.2 kg。受者最常见的原发病为先天性肾病综合征(13例,41.9%)。19例(51.3%)采用腹腔内移植,其余18例(48.6%)采用髂窝内移植。7例(18.9%)术后肾功能恢复延迟,5例(13.5%)因血栓形成导致肾功能丧失,其中4例接受再次肾移植并成功。随访期间,发生急性排斥反应11例(29.7%),巨细胞病毒肺炎6例(16.2%)。移植后1年的估计肾小球滤过率高于术后1个月[(101.9±22.1) vs (71.1±25.6)ml/(min·1.73m²),P<0.001],移植后2年保持稳定。移植肾1年和2年生存率均为85.3%,受者1年和2年生存率均为96.8%。虽然婴幼儿肾移植实施困难,但仍可取得较为满意的疗效及预后。

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