Indudhara R, Joseph D B, Pérez L M, Diethelm A G
Department of Surgery, University of Alabama at Birmingham, USA.
J Urol. 1998 Sep;160(3 Pt 2):1201-3; discussion 1216.
Renal transplantation is safe and effective for end stage renal disease in children with posterior urethral valves. We previously reported our 5-year post-transplantation results in boys with posterior urethral valves and matched controls. Graft survival was similar. However, we were concerned about elevated serum creatinine and the potential detrimental effects of hostile bladder dynamics in these children. We performed this study to determine whether our concern would be substantiated.
We retrospectively analyzed the clinical records and computerized transplantation database in 268 boys younger than 19 years who underwent renal transplantation from May 1968 through November 1988. The 18 children with posterior urethral valves were compared to a nonobstructed cohort of 18 boys in regard to age, number of transplants, donor type and immunosuppression. All children had at least 10 years of followup (range 10 to 19).
The 10-year post-transplant patient survival in the posterior urethral valves and control groups was 94 and 100%, while 10-year graft survival was 54 and 41%, respectively. There was no statistically significant difference in graft survival when comparing immunosuppression type, donor source and pre-transplant proximal urinary diversion. The 10-year mean serum creatinine was 2.3 and 2.0 mg./dl. in the posterior urethral valve and control groups, respectively (not statistically significant).
Our renal transplantation results in children with posterior urethral valves are comparable to those in children with nonobstructive end stage renal disease. The 10-year graft survival was better but not statistically significant in the posterior urethral valve group, while serum creatinine was similar. Our concern regarding renal transplantation in children with posterior urethral valves was not substantiated.
对于患有后尿道瓣膜的儿童终末期肾病患者，肾移植是安全有效的。我们之前报告了患有后尿道瓣膜男孩及匹配对照组的肾移植术后5年结果。移植肾存活率相似。然而，我们担心这些儿童血清肌酐升高以及不良膀胱动力学的潜在有害影响。我们进行本研究以确定我们的担忧是否得到证实。
我们回顾性分析了1968年5月至1988年11月期间接受肾移植的268名19岁以下男孩的临床记录和计算机化移植数据库。将18名患有后尿道瓣膜的儿童与18名无梗阻的男孩队列在年龄、移植次数、供体类型和免疫抑制方面进行比较。所有儿童均至少随访10年（范围10至19年）。
后尿道瓣膜组和对照组的移植术后10年患者存活率分别为94%和100%，而10年移植肾存活率分别为54%和41%。比较免疫抑制类型、供体来源和移植前近端尿路改道时，移植肾存活率无统计学显著差异。后尿道瓣膜组和对照组的10年平均血清肌酐分别为2.3和2.0mg/dl（无统计学显著差异）。
我们对患有后尿道瓣膜儿童的肾移植结果与无梗阻终末期肾病儿童的结果相当。后尿道瓣膜组的10年移植肾存活率更高，但无统计学显著差异，而血清肌酐相似。我们对患有后尿道瓣膜儿童肾移植的担忧未得到证实。
