低龄心脏停跳供者单个肾脏成人移植11例

目的 总结符合脑死亡诊断标准的低龄患儿心脏停跳后供肾应用于成人移植的处理经验.方法 心跳停止后单个供肾患儿6例,月龄49～106(75.35±22.8)个月,体质量16.6～37.8(23.9±8.4)kg.受者11例,平均年龄(28.2±7.9)岁,体质量(46.9±4.2)kg.单个供肾植入受者右侧髂窝.手术方法同成人尸肾移植.术中开始单/多克隆抗体加甲泼尼龙诱导治疗,术后常规环孢素或他克莫司、霉酚酸酯、泼尼松三联免疫抑制剂治疗.结果 受者肾功能均恢复正常,其中出现移植肾功能延迟恢复3例.术后移植肾增大明显,灌注后和移植后1周移植肾长径分别为(70.6±5.5)和(86.1±6.9)mm(P＜0.001),之后移植肾持续缓慢增大,至术后12个月移植肾长径为(104.5±8.8)mm.平均随访时间(21.8±9.5)个月,1年人/肾存活率均为100%.结论 低龄心跳停止供者单个供肾植入低体重的成人受者,可以成功维持受者正常肾功能,1年人/肾存活率与成人尸肾移植无显著差异.

Eleven cases of solitary kidney transplantation from pediatric donor after controlled circulatory death into adult recipient

Objective To summarize the experience of single kidney from pediatric donors after controlled circulatory death transplanted into adult patients.Methods A retrospective single-center review of all adult recipients who received a single pediatric kidney from controlled cardiac deceased donor≤9-year old between January 2006 and March 2008.All donors were diagnosed as brain death and their parents signed the agreement of donation.Patients were observed for 5 to 15 min before cardiac death was declared and the organ-donation process initiated.The mean age and weight were(75.3±22.8)months and(23.9±8.4)kg of the pediatric donors,and(28.2±7.9)years and(46.9±4.2)kg of the aduh recipients.Single kidneys with more than 6cm in length were implanted into the right iliac fossa of recipients through same surgical procedures as in adult cadaveric renal transplantation.Immunosuppression consisted of induction therapy with poly/mono-clone immunoglobulin begun in the operating room prior to revascularization of the graft and continued for 7 days,followed by cyclosporine or tacrolimus-based triple therapy.Results All recipients recovered normal kidney function before leaving hospital.Three of them had delayed graft function.The graft lengths recorded immediately after reperfusion and that in the first week post-transplantation were 70.6±5.5 vs.86.1±6.9 mm (P＜0.00 1).Acute rejection episodes occurred in 1 patient.The one year patient/graft survival was 100%/100%.Conclusions Single kidneys more than 6 cm in length from pediatric donors after controlled cardiac death transplanted into adult recipients with small body mass index can successfully maintain normal renal function.The use of these grafts could expand the donor pool without comprising recipient outcomes.