Laine J, Fyhrquist F, Holmberg C
II Department of Pediatrics, University of Helsinki, Finland.
Nephrol Dial Transplant. 1994;9(10):1468-73.
Results of renal transplantation using cadaver donors (CAD) are usually inferior to those using living related donors (LRD). We have previously reported 100% 1-year CAD and LRD graft survival using adult cadaver donors and triple immunosuppression. In the present study glomerular and tubular function of 23 LRD and 22 CAD grafts (median ages 3.5 and 2.6 years) were compared during 3 years after transplantation. Glomerular filtration rate (GFR) and renal plasma flow were lower in CAD grafts but remained stable in both groups. The mean GFRs were 87.3 and 63.2 ml/min/1.73 m2 at discharge and 82.8 and 72.5 ml/min/1.73 m2 at 36 months in LRD and CAD grafts respectively. No significant differences were found after 6 months. Tubular function was good in both groups. The only significant difference was in urate handling at 36 months (mean serum urate 396 mumol/l in CAD, 301 in LRD grafts, P < 0.05). Cyclosporin nephrotoxicity manifested as hyperkalaemia due to reduced distal potassium secretion and/or adrenal suppression. In conclusion, donor source had little effect on the development of progressive allograft dysfunction using adult CAD grafts and triple immunosuppression with CsA administered in three daily doses to preschool children.
使用尸体供体（CAD）进行肾移植的结果通常不如使用活体亲属供体（LRD）。我们之前曾报道，使用成年尸体供体和三联免疫抑制方案，1年的CAD和LRD移植物存活率均为100%。在本研究中，对23例LRD移植物和22例CAD移植物（中位年龄分别为3.5岁和2.6岁）在移植后3年内的肾小球和肾小管功能进行了比较。CAD移植物的肾小球滤过率（GFR）和肾血浆流量较低，但两组均保持稳定。LRD移植物和CAD移植物出院时的平均GFR分别为87.3和63.2 ml/min/1.73 m²，36个月时分别为82.8和72.5 ml/min/1.73 m²。6个月后未发现显著差异。两组的肾小管功能均良好。唯一的显著差异在于36个月时的尿酸处理（CAD移植物的平均血清尿酸为396 μmol/l，LRD移植物为301 μmol/l，P < 0.05）。环孢素肾毒性表现为由于远端钾分泌减少和/或肾上腺抑制导致的高钾血症。总之，对于学龄前儿童使用成人CAD移植物和每日三次给予CsA的三联免疫抑制方案，供体来源对移植物进行性功能障碍的发展影响不大。
