Benetti Elisa, Bertazza Partigiani Nicola, Moi Marco, Sangermano Maria, Fascetti Leon Francesco, Meneghini Luisa, Daverio Marco, De Corti Federica
Pediatric Nephrology, Department of Women's and Children's Health, Padua University Hospital, 35128 Padua, Italy.
Laboratory of Immunopathology and Molecular Biology of the Kidney, Institute of Pediatric Research "Città della Speranza", Department of Women's and Children's Health, Padua University Hospital, 35128 Padua, Italy.
J Clin Med. 2025 Jul 10;14(14):4905. doi: 10.3390/jcm14144905.
: Kidney transplantation is the treatment of choice for pediatric patients with end-stage kidney disease. However, transplantation in children weighing < 15 kg remains challenging due to limited donor availability and higher surgical and medical risks. We report our 35-year single-center experience in this population, focusing on perioperative and long-term outcomes. : We retrospectively analyzed kidney transplants performed from 1987 to 2023 in children weighing < 15 kg. Data on demographics, donor type, complications, immunosuppression, and outcomes at 2, 5, and 10 years (including survival, graft function, rejection, infections, and urological issues) were collected. Outcomes were compared between deceased and living donors and between recipients weighing < 10 kg and ≥10 kg. : Ninety-six transplants were included (mean age 3.3 years; mean weight 11.1 kg), 80 from deceased and 16 from living donors. Most patients (69.8%) had been treated with peritoneal dialysis. Median follow-up was 120 months. Patient survival was 95.8%; graft survival was 78.1%. Eight grafts (8.3%) were lost to renal vein thrombosis, all in deceased-donor recipients ( = 0.60). Preserved renal function (eGFR > 60 mL/min/1.73 m) declined from 80.4% at 2 years to 66.0% at 5 years and 18.0% at 10 years. Graft survival at 10 years was significantly lower in children < 10 kg vs. ≥10 kg (49.6% vs. 80.3%, = 0.003). CAKUT was associated with higher urological complication rates ( = 0.017). No significant differences emerged between living and deceased donor groups. : Transplantation in children < 15 kg is feasible with good outcomes, but those <10 kg present lower graft survival at 10 years. Multidisciplinary assessment and center experience are key to optimizing results.
肾移植是终末期肾病小儿患者的首选治疗方法。然而，由于供体来源有限以及手术和医疗风险较高，体重<15kg的儿童进行肾移植仍然具有挑战性。我们报告了我们在这一人群中35年的单中心经验，重点关注围手术期和长期结果。我们回顾性分析了1987年至2023年期间为体重<15kg的儿童进行的肾移植手术。收集了人口统计学、供体类型、并发症、免疫抑制以及2年、5年和10年时的结果（包括生存率、移植肾功能、排斥反应、感染和泌尿系统问题）等数据。比较了 deceased 供体和活体供体以及体重<10kg和≥10kg的受者之间的结果。纳入了96例移植手术（平均年龄3.3岁；平均体重11.1kg），其中80例来自 deceased 供体，16例来自活体供体。大多数患者（69.8%）接受过腹膜透析治疗。中位随访时间为120个月。患者生存率为95.8%；移植肾生存率为78.1%。8例移植肾（8.3%）因肾静脉血栓形成而丢失，均为 deceased 供体受者（P = 0.60）。肾功能保留（估算肾小球滤过率>60mL/min/1.73m²）从2年时的80.4%下降至5年时的66.0%和10年时的18.0%。10岁时，体重<10kg的儿童与≥10kg的儿童相比，移植肾生存率显著较低（49.6%对80.3%，P = 0.003）。先天性肾脏和尿路畸形（CAKUT）与较高的泌尿系统并发症发生率相关（P =
0.017）。活体供体组和 deceased 供体组之间未出现显著差异。体重<15kg的儿童进行肾移植是可行的，且结果良好，但体重<10kg的儿童在10年时移植肾生存率较低。多学科评估和中心经验是优化结果的关键。
