Lerner S E, Griefer I, Taub H C, Greenstein S M, Schechner R, Karwa G, Melman A, Tellis V
Department of Urology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York 10467.
J Urol. 1993 Mar;149(3):549-52. doi: 10.1016/s0022-5347(17)36144-x.
Results of pediatric renal transplantation have been variable. We evaluated our experience with renal transplantation in children less than 5 years old to determine its safety and efficacy. Of the 428 renal transplants done at our institution from August 1983 to December 1989, 14 were performed in 13 children 13 to 50 months old (mean age 34 months). All of the patients were small for age with height standard deviation scores ranging from -1.7 to -4.5. Patient survival, allograft survival and statural growth were used as determinants of successful outcome. Followup was complete in all patients, including renal function studies and serial height measurements. Growth velocity standard deviation scores were calculated. Patient survival was 100%. Allograft survival was 100% 2 to 7.3 years after transplantation for living related donor recipients whereas 1-year graft survival was poor (40%) for cadaveric graft recipients. Of 10 patients with good graft function at 1 year 9 demonstrated improvement in the height standard deviation score. Seven of 10 patients demonstrated significant catch-up growth (growth velocity standard deviation score greater than 0, p = 0.04). Our study supports the safety and efficacy of renal transplantation in young children. Early transplantation using living-related donor organs is the optimal therapy to prevent growth retardation and allow the young child with end stage renal disease to have a normal life.
小儿肾移植的结果各不相同。我们评估了我们在5岁以下儿童肾移植方面的经验，以确定其安全性和有效性。在1983年8月至1989年12月期间，我们机构共进行了428例肾移植手术，其中14例是为13名年龄在13至50个月（平均年龄34个月）的儿童进行的。所有患者均低于同龄人身高，身高标准差分数在-1.7至-4.5之间。患者生存率、移植肾生存率和身高增长情况被用作成功结果的决定因素。对所有患者进行了完整的随访，包括肾功能研究和连续的身高测量。计算了生长速度标准差分数。患者生存率为100%。活体亲属供肾受者移植后2至7.3年移植肾生存率为100%，而尸体供肾受者1年移植肾生存率较差（40%）。在10例术后1年移植肾功能良好的患者中，9例身高标准差分数有所改善。10例患者中有7例出现显著的追赶生长（生长速度标准差分数大于0，p = 0.04）。我们的研究支持小儿肾移植的安全性和有效性。早期使用活体亲属供肾进行移植是预防生长发育迟缓并使终末期肾病患儿过上正常生活的最佳治疗方法。
