儿童心脏死亡器官捐献供者双肾整块移植早期临床疗效观察

目的：观察儿童心脏死亡器官捐献（ DCD ）供者双肾整块移植的早期临床疗效。方法回顾性分析中山大学附属第一医院器官移植中心2010年2月至2013年9月儿童DCD供者双肾整块移植供、受者临床资料。6例儿童DCD供者中位年龄3岁（10个月～6岁），均捐献给相同血型受者。6例受者中位年龄39．5岁（17～48岁），成年人5例，17岁男性1例，原发病均为慢性肾小球肾炎；均为首次肾移植，群体反应性抗体均阴性， HLA错配数1～4个。均采用右侧髂窝整块移植法。结果6例受者手术均获成功。移植肾热缺血时间中位数为17．5 min （0～23 min），冷缺血时间中位数为6．6 h （4．8～7．4 h）。术后肾功能恢复均较顺利，未发生急性排斥反应、移植肾原发性无功能和移植肾功能延迟。其中4例为移植肾功能立即恢复（即术后第5天血清肌酐≤265μmol/L ），2例为移植肾功能缓慢恢复（即术后第5天血清肌酐＞265μmol/L）。1例受者术后7 d右侧移植肾动脉血栓形成；1例受者术后15 d诊断为肺结核行正规抗结核治疗；1例受者术后1年出现移植肾动脉吻合口狭窄，介入治疗后恢复。术后随访1～36个月，受者和移植肾全部存活，所有受者肾功能均正常。结论儿童DCD供者双肾整块移植早期临床疗效良好，是一种扩大供者来源的良好途径。

Effect of en bloc kidney transplantation from cardiac death pediatric donors

Objective To study the early clinical effect of en bloc kidney transplantation from pediatric donors with donation after cardiac death .Method We retrospectively analyzed the data of 6 en bloc kidney transplantations from pediatric donors with donation after cardiac death in our center .The transplant operations were carried out between February 2010 to September 2013 .The median age of pediatric donor was 3 years （10 months to 6 years）, all recipients had the same blood type match to donors.All donors, renal function were kept well excepted 2 donors with 6-year-old （ serum Cr 155 μmolL/and160 μmol/L）.The median age of recipients was 39.5 years（17 to 48 years）and 5 recipients were adults.The primary renal disease was chronic glomerulonephritis in all 6 recipients.All patients were first received kidney transplantation;panel reactive antibodies （ PRA） were negative;and HLA mismatch between 1 to 4.All recipients carried out en bloc kidney transplantation in right fossa iliaca.Resutl s Six kidney transplantations were success .The median warm ischemic time of renal allograft was 17.5 min （0 -23 min）, cold ischemic time was 6.6 h （4.8 -7.4 h）.The renal allografts recovered uneventfully after transplantation , no delayed graft function and primary nonfunction occurred.Immediate graft function occurred in 4 cases and slow graft function occurred in 2.The postoperative complications included 1 case of arterial thrombosis of right kidney 7 d after transplantation, 1 of pulmonary tuberculosis 15 d after transplantation and 1 of arterial anastomotic stenosis 1 year after transplantation .All renal grafts functions were well during the follow-up period between 1 month and 3 years.Conclusion The early clinical effect of en bloc kidney transplantation from pediatric donors with donation after cardiac death is excellent .So we believe it is a promising pathway to expand the organ donor pool .