Burren C P, Jones C L, Francis D M, Powell H R, Walker R G
Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Vic.
Aust N Z J Med. 1995 Apr;25(2):122-6. doi: 10.1111/j.1445-5994.1995.tb02823.x.
To review the outcome of renal transplantation in small children treated with triple immunosuppression at a single Australian centre.
The medical records of all children under the age of five years undergoing renal transplantation from 1988 were reviewed. The duration of follow-up was 30 months (range 18-36).
Six children received seven renal allografts (five living-related [LR] and two cadaveric [CD]). They had a median age of 3.75 years (range 1.5-4.9) and weight of 11.6 kg (9.1-14.5) at the time of transplantation. All patients received an immunosuppressive regime involving cyclosporin A, azathioprine and prednisolone. There were no deaths. The only graft lost was a CD graft (severe acute rejection within one week of transplantation). Hypertension occurred in all recipients and usually required more than one antihypertensive drug for treatment. Renal function measured by serum median creatinine concentration (range) was 0.05 mmol/L (0.03-0.11) at three months (n = 6) and 0.10 mmol/L (0.07-0.22) at 30 months (n = 4). Growth estimated from median (range) height standard deviation scores was -1.97 (-1.36-(-4.04)) at three months (n = 6) and -1.90 (-1.74-2.50) at 30 months (n = 4). No patient was entirely weaned from prednisolone. Cyclosporin A side effects included hirsutism (five patients), gingival hyperplasia (six patients) and nephrotoxicity (three patients).
Satisfactory patient and graft survival can be accomplished in this recipient age group. The results compare with other international experience and accumulating Australian experience. Hypertension and poor skeletal growth were consistent observations. The long-term outcome of renal function using triple immunosuppression remains to be determined.
回顾澳大利亚某单一中心采用三联免疫抑制疗法治疗的小儿肾移植结果。
对1988年以来所有接受肾移植的5岁以下儿童的病历进行回顾。随访时间为30个月（范围18 - 36个月）。
6名儿童接受了7次肾移植（5次活体亲属供肾[LR]和2次尸体供肾[CD]）。移植时他们的中位年龄为3.75岁（范围1.5 - 4.9岁），体重为11.6千克（9.1 - 14.5千克）。所有患者均接受了包含环孢素A、硫唑嘌呤和泼尼松龙的免疫抑制方案。无死亡病例。唯一丢失的移植物是1次尸体供肾移植物（移植后1周内发生严重急性排斥反应）。所有受者均出现高血压，通常需要使用不止一种抗高血压药物进行治疗。以血清肌酐中位数浓度（范围）衡量的肾功能在3个月时为0.05毫摩尔/升（0.03 - 0.11）（n = 6），在30个月时为0.10毫摩尔/升（0.07 - 0.22）（n = 4）。根据身高标准差评分中位数（范围）估算的生长情况在3个月时为 -1.97（-1.36 -（-4.04））（n = 6），在30个月时为 -1.90（-1.74 - 2.50）（n = 4）。无患者完全停用泼尼松龙。环孢素A的副作用包括多毛症（5例患者）、牙龈增生（6例患者）和肾毒性（3例患者）。
在这个受者年龄组中可以实现令人满意的患者和移植物存活率。结果与其他国际经验以及澳大利亚不断积累的经验相当。高血压和骨骼生长不良是常见的观察结果。三联免疫抑制疗法对肾功能的长期影响仍有待确定。
