儿童亲属肾脏移植的临床研究

目的 探讨儿童亲属患者肾移植的疗效及其优越性,研究儿童肾脏移植手术方案、术后免疫抑制药物应用的特点以及术后并发症的处理.方法 分析14例肾移植患儿的临床资料、肾脏移植手术方法、免疫抑制剂应用和随访情况.结果 移植术后早期主要并发症:移植肾急性排斥反应2例,严重高钠血症3例,泌尿系感染1例,移植肾周积液3例.长期主要并发症:高血压6例、高脂血症3例、各种感染4例、药物性肝损害5例.1年人/肾存活率均为100%,研究结束时,14例患儿平均血肌肝为96.43 mmol/L(43～125 mmol/L),所有患儿均认为移植术后生活质量明显提高. 结论 亲属肾移植是治疗儿童慢性肾功能不全最为理想的方法,儿童肾移植的术式应根据受者血管情况选择.术后免疫抑制治疗建议联合应用他克莫司+霉酚酸酯+激素.

Living donor kidney transplantation in child: a report of 14 cases

Objective To explore the benefits of living donor kidney transplantation in child, and to inves-tigate the procedures of renal transplantation, post-operative immunosuppressants regimens and complication management in child. Methods Clinical data, the prognosis of renal transplantation, operative procedure and immunosuppressive agents administrated in 14 children with end-stage renal disease (ESRD) undergo-ing renal transplantation were analyzed. Results The major complications in the early stage after renal transplantation were: 2 cases had acute rejection, 3 cases had severe hypernatremia, 1 case had urological infection, 3 cases had lymphocele. The major complications in the long-term recipients included: 6 cases had hypertension, 3 cases had hyperlipidemia, 4 cases had various kinds of infections, 5 cases had drug-in-duced hepatic injury. The one year survival rates of recipient/graft were all 100%. The average creatinine was 96.43 mmol/L(43-125 mmol/L) for the 14 recipients by the end of this study. All recipients thought their life quality was improved significantly. Conclusions Living donor kidney transplantation is the most ideal method to treat children with ESRD. Adult donor kidneys are suitable to the school age of recipients. The protocol of immunosuppressive therapy (prednisone plus MMF and FKS06) should be applied.