儿童肾移植的远期预后

目的探讨儿童肾移植的长期存活情况及其对生长发育、就业、婚育的影响。方法以27例肾移植5年以上的儿童受者为研究对象作回顾性分析。结果本组受者术后1、3、5、10年人存活率分别为100%、92.6%、85.8%、68.6%,1、3、5、10年肾存活率分别为96.3%、89.2%、82.6%、66.1%,均采用以环孢素A或他克莫司为基础的二联或三联免疫抑制方案,移植后第1年体重增加4～10kg,女性增高0～2cm,男性增高2～5cm。术后接受初中以上教育者占44.4%。现存活的20例受者年龄20～39岁,男性就业率46.2%(6/13),女性57.2%(5/7),已婚12例(60%),男性生育5例,女性生育3例,子女均健康,服药不依从比例占30%,主要并发症包括高血压(40%)、高血脂(30%)、牙龈增生(30%)、多毛(25%)、肝功能损害(20%)、单纯疱疹(15%)、糖尿病(5%)、白内障(5%)。死亡7例,死亡年龄21～39岁,分别死于感染(28.6%)、肝功能损害(28.6%)、心衰(42.8%)。结论肾移植是终末期肾功能衰竭儿童的最佳治疗方法,应重视受者的不依从行为,合理使用免疫抑制剂。呼吁社会各界对移植受者给予就业等多方面的支持。

The long-term results of pediatric kidney transplantation

Objective To explore the long-term results of pediatric kidney transplantation and the effect of renal allograft on the growth,development,employment,marriage and breed.Methods Twenty-seven children with end-stage renal disease (ESRD) received the renal allograft five years ago. The survival rates of patient and kidney,renal function,stature,and employment were analyzed retro- spectively.Results The 1-,3-,5-,10-year graft survival rates were 96.3%,89.2%,82.6% and 66.1%,respectively,and the corresponding patient survival rates were 100%,92.6%,85.8% and 68.6%.The maintenance immunosuppressive protocol for all 27 patients included cyclosporine com- bined with prednisolone (2 cases),or cyclosporine combined with azathioprine (5 cases),mycopheno- late mofetil (12 cases),and tacrolimus combined with mycophenolate mofetil (8 cases).The body weight was increased 4 to 10 kg and the body height was increased 0 to 2 cm in girls and 2 to 5cm in boys during the first year post-transplantation.Thirteen (44.4%) recipients continued to accomplish their education above junior high school.The employment rate was 46.2% in boys,and 57.2% in girls.Twelve patients were married,and 5 male and 3 female patients had healthy children.Noncom- pliance was in 30% of the recipients.The main complications included hypertension (40%),hyperlipi- demia (30%),gingival hyperplasia (30%),crinosity (25%),impaired liver function (20%),simple herpes zoster (15%),diabetes mellitus (5%) and cataract (5%).Seven patients died at the age ranged from 21 to 39 years.The causes of death were infection (n=2),impaired liver function (n=2) and heart failure (n=3).Conclusions The satisfactory long-term results can be gained after rational use immunosuppressive agents in children with renal transplantation.