Humar A, Nevins T E, Remucal M, Cook M E, Matas A J, Najarian J S
Department of Surgery, University of Minnesota, Minneapolis, USA.
Ann Surg. 1998 Sep;228(3):421-8. doi: 10.1097/00000658-199809000-00015.
The optimal age for transplantation in children with end-stage renal disease remains controversial. Supported by national data, many centers recommend dialysis until the child reaches a certain minimum age. The authors' policy, however, has been to encourage living donor (LD) transplants for young children, with no minimum age restriction.
Between January 1, 1984, and December 31, 1996, the authors performed 248 kidney transplants in children younger than age 13 years, using cyclosporine as the primary immunosuppressive agent. Recipients were analyzed in three age groups: group 1, younger than age 1 year (n = 26); group 2, age 1 through 4 (n = 92); and group 3, age 5 through 13 (n = 130). Almost all recipients in group 1 underwent a primary LD transplant. Therefore, to compare results more meaningfully among the three age groups, only primary LD transplants were analyzed (group 1, n = 25; group 2, n = 59; group 3, n = 58).
In primary LD transplants, no significant difference was noted among the age groups in 1-and 5-year patient or graft survival rates. To date, all 25 recipients from group 1 are alive and well; 19 still have a functional original graft. Causes of graft loss in the remaining six recipients were chronic rejection (n = 3), vascular thrombosis (n = 2), and recurrent disease (n = 1). The incidence of acute rejection in group 1 recipients was lower than in the two older groups. However, the incidence of delayed graft function was slightly higher in the youngest group than in the two older groups. For recipients in group 1, growth (as measured by weight) improved significantly posttransplant: the mean standard deviation score rose from -2.8 pretransplant to -0.2 by age 5 and to +1.8 by age 10. The improvement in height was not as dramatic: the mean standard deviation score rose from -3.2 pretransplant to -1.6 by age 5 and to -1.4 by age 10.
Kidney transplantation in young children, including those younger than 1 year old, can achieve results comparable to those in older children. As long as an adult LD is available, the timing of the transplant should be based on renal function rather than age.
终末期肾病患儿的最佳移植年龄仍存在争议。在国家数据的支持下，许多中心建议进行透析，直到儿童达到一定的最低年龄。然而，作者的政策一直是鼓励为幼儿进行活体供肾（LD）移植，没有最低年龄限制。
在1984年1月1日至1996年12月31日期间，作者使用环孢素作为主要免疫抑制剂，为13岁以下的儿童进行了248例肾移植。将受者分为三个年龄组进行分析：第1组，年龄小于1岁（n = 26）；第2组，年龄1至4岁（n = 92）；第3组，年龄5至13岁（n = 130）。第1组几乎所有受者都接受了初次LD移植。因此，为了更有意义地比较三个年龄组的结果，仅分析初次LD移植（第1组，n = 25；第2组，n = 59；第3组，n = 58）。
在初次LD移植中，各年龄组在1年和5年的患者或移植物存活率方面没有显著差异。迄今为止，第1组的所有25名受者均存活且状况良好；19人仍有一个功能正常的原始移植物。其余6名受者移植物丢失的原因是慢性排斥反应（n = 3）、血管血栓形成（n = 2）和疾病复发（n = 1）。第1组受者的急性排斥反应发生率低于两个较大年龄组。然而，最年幼组的移植肾功能延迟发生率略高于两个较大年龄组。对于第1组的受者，移植后生长（以体重衡量）有显著改善：平均标准差评分从移植前的-2.8升至5岁时的-0.2，10岁时升至+1.8。身高的改善没有那么显著：平均标准差评分从移植前的-3.2升至5岁时的-1.6，10岁时升至-1.4。
幼儿肾移植，包括1岁以下的儿童，能够取得与大龄儿童相当的结果。只要有成年活体供者，移植时机应基于肾功能而非年龄。
