Bretan P N, Friese C, Goldstein R B, Osorio R W, Tomlanovich S, Amend W, Mathur V, Vincenti F
Department of Surgery, University of California School of Medicine at San Francisco, USA.
Transplantation. 1997 Jan 27;63(2):233-7. doi: 10.1097/00007890-199701270-00010.
Renal transplantation using infant donors is associated with significantly less graft survival (GS) and increased morbidity, especially from very young and small donors. We report our results using specific strategies to determine which age and size donor require en bloc renal transplant reconstruction and associated immunologic protocols for optimization of subsequent GS. Forty cadaveric pediatric en bloc renal transplants were performed. Mean donor age was 23.6+/-18.4 months with subgroups: 2-12 months, n=14; 13-24 months, n=19; and 25-60 months, n=7. Mean donor weight was 14.4+/-4.5 kg. All kidneys were placed in primary, nonsensitized (peak PRA = 7.9+/-5.6%) adult (41.6+/-16 years) recipients. Low weight was preferred (62.4+/-12.8 kg). Mean cold ischemia time was 26.9+/-8.6 hr. Immunosuppression consisted of quadruple immunosuppression (QI) with OKT3 induction. All patients had ureteral stents placed intraoperatively. Mean follow-up was 16.9 months. Actuarial GS at 12, 24, and 33 months were 100% (n=13), 85% (n=20), and 71% (n=7), respectively. Total GS was 35/40=88%. All grafts functioned immediately and there were no technical losses. Biopsy proven rejections occurred in 12 (30%) patients, developing at 16-167 days postoperatively (mean = 50.3 days). Mean serum creatinine at one week and 1, 6, 12, and 18 months were 2.1+/-2.0, 1.5+/-0.8, 1.3+/-0.5, 1.1+/-0.4, and 0.9+/-0.4 mg/dl, respectively. Functional isotopic renography, as well as sonographic monitoring reflected rapid initial and continued growth in these kidneys. Mean BP at 12 and 24 months postoperatively were 145/83+/-18/13 and 122/76+/-20/10 mmHg, respectively, with no significant proteinuria noted. Excellent results with minimal complications utilizing very small and young infant donors can be achieved with QI immunosuppression, and selection of low immune reactive and noncomplicated adult recipients. Additionally, maximal renal dosing by minimizing recipient weight may prevent future hyperfiltration damage.
使用婴儿供体进行肾移植与显著较低的移植物存活率（GS）及发病率增加相关，尤其是来自非常年幼和体型小的供体。我们报告了使用特定策略的结果，以确定哪些年龄和体型的供体需要进行整块肾移植重建以及相关的免疫方案，以优化后续的GS。共进行了40例尸体小儿整块肾移植。供体平均年龄为23.6±18.4个月，分为亚组：2 - 12个月，n = 14；13 - 24个月，n = 19；25 - 60个月，n = 7。供体平均体重为14.4±4.5千克。所有肾脏均植入初次、未致敏（峰值PRA = 7.9±5.6%）的成年（41.6±16岁）受者体内。偏好低体重受者（62.4±12.8千克）。平均冷缺血时间为26.9±8.6小时。免疫抑制采用含OKT3诱导的四联免疫抑制（QI）。所有患者术中均放置输尿管支架。平均随访时间为16.9个月。12个月、24个月和33个月时的精算GS分别为100%（n = 13）、85%（n = 20）和71%（n = 7）。总GS为35/40 = 88%。所有移植物立即发挥功能，无技术失败情况。经活检证实的排斥反应发生在12例（30%）患者中，术后16 - 167天出现（平均 = 50.3天）。术后1周、1个月、6个月、12个月和18个月时的平均血清肌酐分别为2.1±2.0、1.5±0.8、1.3±0.5、1.1±0.4和0.9±0.4毫克/分升。功能性同位素肾图以及超声监测反映了这些肾脏最初的快速生长及持续生长情况。术后12个月和24个月时的平均血压分别为145/83±18/13和122/76±20/10毫米汞柱，未发现明显蛋白尿。通过QI免疫抑制以及选择低免疫反应性且无并发症的成年受者，利用非常小的年幼婴儿供体可取得并发症极少的优异结果。此外，通过尽量减轻受者体重实现最大肾剂量给药可能预防未来的超滤损伤。
