Modlin C, Novick A C, Goormastic M, Hodge E, Mastrioanni B, Myles J
Department of Urology (Section of Renal Transplantation), Cleveland Clinic Foundation, Ohio 44195, USA.
J Urol. 1996 Sep;156(3):890-5.
We investigated whether transplantation of single pediatric donor kidneys into adults leads to an increased incidence of functional allograft impairment and complications, as previously reported.
To evaluate long-term functional outcome using single pediatric donor kidneys 60 adults (study group) who underwent transplantation between March 1973 and December 1988 using single pediatric donor kidneys 6 years old or younger (mean donor age plus or minus standard deviation 41.1 +/- 17.9 months) were compared to 58 matched adults (control group) who underwent transplantation with adult kidneys (mean donor age 29.7 +/- 10.8 years). The groups were identical for era of transplantation, recipient age, sex and followup (82 versus 83 months).
There was no difference in patient survival between the study and control groups (p = 0.26). In the study group there were an increased requirement for early dialysis (45 versus 24%, p = 0.02), a higher incidence of proteinuria (greater than 0.8 gm./24 hours, 67 versus 48%, p = 0.04) and a higher incidence of rejection within the first 6 months (80 versus 64%, p = 0.05). There was also an increased incidence of graft failure from acute rejection in the study group. Early differences in serum creatinine levels in the 2 groups dissipated after 3 months. Renal allograft histopathology revealed no significant difference in the incidence of focal segmental glomerulosclerosis in the study versus control groups after transplantation (22.9 versus 13.3%, p = 0.70). However, focal segmental glomerulosclerosis manifested sooner after transplantation in study than control patients (mean 37 versus 82 months). After transplantation proteinuria developed in study patients with focal segmental glomerulosclerosis at a mean of 4.6 months compared to 31.8 months in controls with post-transplant focal segmental glomerulosclerosis. Graft survival in the study group was superior when cyclosporine was given rather than conventional noncyclosporine based immunosuppression. Five-year graft survival rates were 48 versus 44% for cyclosporine treated and 33 versus 44% for conventionally treated study versus control patients.
These data suggest that with cyclosporine immunosuppression transplanting single pediatric kidneys into adults yields the same long-term functional graft outcome as adult donor kidneys.
如先前报道，我们研究了将单个小儿供肾移植给成人是否会导致功能性移植肾损害和并发症的发生率增加。
为评估使用单个小儿供肾的长期功能结果，将1973年3月至1988年12月期间接受6岁及以下（平均供体年龄加减标准差41.1 +/- 17.9个月）单个小儿供肾移植的60名成人（研究组）与58名匹配的接受成人供肾移植的成人（对照组）（平均供体年龄29.7 +/- 10.8岁）进行比较。两组在移植时代、受者年龄、性别和随访时间（分别为82个月和83个月）方面相同。
研究组和对照组的患者生存率无差异（p = 0.26）。研究组早期透析需求增加（45%对24%，p = 0.02），蛋白尿发生率更高（大于0.8克/24小时，67%对48%，p = 0.04），且前6个月内排斥反应发生率更高（80%对64%，p = 0.05）。研究组因急性排斥导致的移植肾失败发生率也增加。两组血清肌酐水平的早期差异在3个月后消失。移植后肾移植组织病理学显示，研究组与对照组局灶节段性肾小球硬化的发生率无显著差异（22.9%对13.3%，p = 0.70）。然而，研究组移植后局灶节段性肾小球硬化出现得比对照组早（平均37个月对82个月）。研究组患有局灶节段性肾小球硬化的患者移植后蛋白尿出现的平均时间为4.6个月，而对照组移植后局灶节段性肾小球硬化患者为31.8个月。当给予环孢素而非传统的非环孢素免疫抑制时，研究组的移植肾存活率更高。环孢素治疗的研究组与对照组患者的5年移植肾存活率分别为48%对44%，传统治疗的为33%对44%。
这些数据表明，在环孢素免疫抑制下，将单个小儿肾脏移植给成人可产生与成人供肾相同的长期功能性移植肾结果。
