Helling T S, Nelson P W, Reed L, Alon U, Hellerstein S, Warady B A
University of Missouri-Kansas City School of Medicine.
Mo Med. 1994 Jan;91(1):33-7.
Renal transplantation for pediatric end stage renal disease (ESRD) is a preferred option in dealing with these chronically ill patients. The pediatric renal transplant program at University of Missouri-Kansas City School of Medicine was begun in 1986 at St. Luke's Hospital and subsequently shifted to the Children's Mercy Hospital as experience was accumulated. To date 35 transplants have been performed in 31 recipients. Fifty-one per cent of the patients transplanted were adolescents (older than 13 years) and 91% of the patients were older than 4 years. Sixteen of the 35 transplants were from living related donors and 19 patients received their kidneys from cadaveric donors. Immunosuppression consisted of corticosteroids, azathioprine, cyclosporine and antilymphoblast globulin. No patients died following transplantation with a functioning kidney. Allograft survival with living related transplants at one year and three years was 91% and 86% respectively. Cadaveric allograft survival at one year and three years was 78% and 46% respectively. Most kidneys were lost due to either acute or chronic rejection although there were three patients who lost their kidney due to primary nonfunction, including one child age 23 months. The growth pattern of all but the youngest children (< or = 2 years) following transplantation showed no evidence of accelerated growth. Results in this early series of pediatric renal transplant patients is encouraging from the standpoint of patient and allograft survival and even though accelerated growth is not seen in the older children, it seems to offer a better quality of life for children with end stage renal disease.
小儿终末期肾病（ESRD）的肾移植是治疗这些慢性病患儿的首选方案。密苏里大学堪萨斯城医学院的小儿肾移植项目始于1986年，最初在圣卢克医院开展，随着经验的积累，后来转移至儿童慈善医院。迄今为止，已为31名受者进行了35例移植手术。接受移植的患者中，51%为青少年（13岁以上），91%的患者年龄超过4岁。35例移植手术中有16例来自活体亲属供体，19例患者接受的是尸体供肾。免疫抑制方案包括使用皮质类固醇、硫唑嘌呤、环孢素和抗淋巴细胞球蛋白。移植后有功能肾的患者均未死亡。活体亲属移植的同种异体肾1年和3年生存率分别为91%和86%。尸体供肾移植1年和3年生存率分别为78%和46%。大多数移植肾失功是由于急性或慢性排斥反应，不过有3例患者因原发性无功能而失去移植肾，其中包括一名23个月大的儿童。除最年幼的儿童（≤2岁）外，其余患儿移植后的生长模式均未显示有加速生长的迹象。从患者和同种异体肾的生存率来看，这组早期小儿肾移植患者的结果令人鼓舞，而且尽管年龄较大的儿童未见加速生长，但肾移植似乎为终末期肾病患儿提供了更好的生活质量。
