Nakatani Ryo, Miura Kenichiro, Ando Taro, Kato Aya, Shirai Yoko, Ishizuka Kiyonobu, Miyauchi Yuki, Ogino Daisuke, Akioka Yuko, Ishida Hideki, Hattori Motoshi
Department of Pediatric Nephrology, Tokyo Women's Medical University, Tokyo, Japan.
Department of Urology, Ehime University Graduate School of Medicine, Ehime, Japan.
Clin Exp Nephrol. 2025 Jan;29(1):99-104. doi: 10.1007/s10157-024-02550-2. Epub 2024 Aug 22.
Kidney transplantation (KT) in children and adolescents with severe motor and intellectual disabilities (SMID) has been a topic of controversy. A multicenter study in Japan showed that KT was not contraindicated for children with multiple handicaps, but no consensus has been reached on KT for patients with SMID. This study aimed to determine whether KT is a viable treatment option for children and adolescents with SMID.
A single-center, retrospective study was conducted on children and adolescents with SMID who underwent KT. SMID was defined based on Oshima's classification. Clinical information was collected through a review of medical records.
Of 453 children and adolescents who underwent KT between 1983 and 2023 in our institution, six (1.3%) patients with SMID were identified. One patient received KT twice. All patients underwent living KT. Five patients used medical devices, including gastrostomy and a ventriculoperitoneal shunt, prior to KT. Perioperative complications, including hemothorax related to central venous catheter insertion, ventilator-associated pneumonia, and common iliac artery thrombosis requiring graftectomy, occurred in three patients. One patient required vesicostomy owing to refractory urinary tract infection. There was no significant difference in the graft survival rate between patients with SMID and those without SMID. One patient developed graft failure and died after selecting conservative kidney management.
Our study showed a favorable graft survival in children and adolescents with SMID who underwent KT. Although careful perioperative management and continued medical care are required, KT may be a viable option for these patients.
对于患有严重运动和智力障碍（SMID）的儿童和青少年进行肾移植（KT）一直是一个有争议的话题。日本的一项多中心研究表明，KT对多重残疾儿童并非禁忌，但对于患有SMID的患者进行KT尚未达成共识。本研究旨在确定KT是否是患有SMID的儿童和青少年的可行治疗选择。
对接受KT的患有SMID的儿童和青少年进行了一项单中心回顾性研究。SMID根据大岛分类法定义。通过查阅病历收集临床信息。
在1983年至2023年期间于我们机构接受KT的453名儿童和青少年中，确定了6名（1.3%）患有SMID的患者。1名患者接受了两次KT。所有患者均接受活体KT。5名患者在KT前使用了医疗设备，包括胃造口术和脑室腹腔分流术。3名患者发生了围手术期并发症，包括与中心静脉导管插入相关的血胸、呼吸机相关性肺炎以及需要进行移植切除的髂总动脉血栓形成。1名患者因难治性尿路感染需要进行膀胱造口术。患有SMID的患者与未患有SMID的患者之间的移植存活率没有显著差异。1名患者在选择保守肾脏管理后发生移植失败并死亡。
我们的研究表明，接受KT的患有SMID的儿童和青少年的移植存活率良好。尽管需要仔细的围手术期管理和持续的医疗护理，但KT可能是这些患者的可行选择。
