影响小儿肾移植短期和长期存活的因素。

Factors influencing short-term and long-term pediatric renal transplant survival.

作者信息

Schurman S J, McEnery P T

机构信息

Department of Pediatrics, University of South Florida College of Medicine, Tampa, USA.

出版信息

J Pediatr. 1997 Mar;130(3):455-62. doi: 10.1016/s0022-3476(97)70210-5.

DOI:10.1016/s0022-3476(97)70210-5

PMID:9063424

Abstract

OBJECTIVE

To determine the patient and donor characteristics important for short-term and long-term renal transplant survival at Cincinnati Children's Hospital Medical Center.

METHODS

Cumulative transplant survival was calculated and univariate analysis of graft survival performed on 206 transplants done since 1970 in 148 pediatric patients. Grafts to black recipients were analyzed separately. Short-term graft survival is defined as 1-year allograft survival and long-term graft survival as graft half-life (t1/2) survival for allografts functioning after the first posttransplant year.

RESULTS

One-year graft survival of living-related donor (LRD) and cadaver donor (CAD) transplants was 77% and 62%, respectively. Graft t1/2 was 11.2 years for LRD and 9.8 years for CAD grafts. The CAD 1-year graft survival when the recipient or donor was younger than 7 years was 36% and 41%, respectively. The LRD 1-year graft survival to children younger than 7 years was 88% versus 75% in older children. Graft survival at 1 year was similar for CAD primary and retransplants (60% vs 65%), but graft t1/2 better for CAD primary grafts (17.8 years vs 5.0 years, P < 0.001). Preemptive LRD grafts performed similarity at 1 year and better over the long term compared with patients who had long-term dialysis (85% vs 74%, P = NS; and 16.9 years vs 8.0 years, p < 0.001). Preemptive CAD grafts did poorly, with 1-year graft survival of 38%. Administration of Cyclosporine A (CsA) improved CAD 1-year graft survival (76% vs 54%, p < 0.001) but not long-term survival. Thirty grafts to 24 black children had a 1-year survival of 48%, with no graft surviving more than 5 years.

CONCLUSIONS

Living-related donor transplantation should be aggressively pursued for young children. If a LRD is unavailable and the young child's medical condition is stable, delay in CAD transplantation should be considered, with dialysis before transplant. Use of CsA improves 1-year pediatric graft survival, but does not improve graft survival after 1 year at the Children's Hospital Medical Center. New strategies to improve graft survival in black children should be pursued.

摘要

目的

确定对辛辛那提儿童医院医疗中心肾移植短期和长期存活至关重要的患者及供体特征。

方法

计算累积移植存活率，并对1970年以来148例儿科患者进行的206例移植的移植物存活情况进行单因素分析。对接受黑人供体移植的情况进行单独分析。短期移植物存活定义为1年同种异体移植物存活，长期移植物存活定义为移植后第一年之后仍在发挥功能的同种异体移植物的半衰期（t1/2）存活。

结果

亲属活体供体（LRD）和尸体供体（CAD）移植的1年移植物存活率分别为77%和62%。LRD移植物的t1/2为11.2年，CAD移植物为9.8年。当受体或供体年龄小于7岁时，CAD移植的1年移植物存活率分别为36%和41%。LRD移植给7岁以下儿童的1年移植物存活率为88%，而给年龄较大儿童的为75%。CAD初次移植和再次移植的1年移植物存活率相似（60%对65%），但CAD初次移植物的t1/2更好（17.8年对5.0年，P<0.001）。与长期透析的患者相比，抢先进行的LRD移植在1年时效果相似，长期效果更好（85%对74%，P=无显著性差异；16.9年对8.0年，P<0.001）。抢先进行的CAD移植效果较差，1年移植物存活率为38%。使用环孢素A（CsA）可提高CAD移植的1年移植物存活率（76%对54%，P<0.001），但不能提高长期存活率。24名黑人儿童接受的30例移植的1年存活率为48%，没有移植物存活超过5年。