儿童肾移植23例临床分析

目的　探讨儿童肾移植的临床特点及围手术期处理特点。方法　回顾性分析平均年龄(15 4± 1 0 )岁的 2 3例儿童肾移植患者的临床资料 ,统计术后移植肾功能变化、急性排斥及并发症发生率。结果　 2 3例手术过程顺利 ,均未出现外科并发症。 1例治疗非顺应致移植肾失去功能 ,2 2例术后平均 5 5d恢复肾功能。术后 6个月内科并发症包括高血压 13例 (5 7% )、肺部感染 4例 (17% )、骨髓抑制与药物性肝损害各 3例 (13% )。术后 1年内急性排斥反应 4例 (17% )。术后第 1年体重平均增加 2 3kg ,身高平均增高 1 0cm。 1年、3年人 /肾生存率分别为 10 0 % / 96 %、90 % / 80 %。结论　肾移植是治疗儿童终末期肾病的有效治疗措施。合适的术式、术后免疫抑制药物的合理应用、并发症的预防和及时治疗是提高人、肾存活率的关键。

Pediatric renal transplantation: clinical analysis of 23 cases

OBJECTIVE: To study the clinical characters and the therapeutic experience of pediatric kidney transplantation. METHODS: Clinical data of 23 pediatric renal transplant recipients (less than 18 years, 14 boys, 9 girls) were analyzed. Recipients were 11 - 17 (mean 15.4 +/- 1.0 years) years old at transplantation. The kidneys were transplanted en bloc extraperitoneally into the recipient's iliac fossa, with the donor renal vein anastomosed to the recipient's external iliac vein. Among 23 transplant procedures, the donor renal artery was anastomosed to the external iliac artery in 14 cases, to the internal iliac artery in 4 cases and to the common iliac artery in 3. The other two allografts were unusual. All the patients were treated with cyclosporine or tacrolimus based immunosuppression, including steroid and azathioprine or mycophenolate mofetil. The initial dose of cyclosporine was 6 - 7 mg per kilogram of body weight per day and that of tacrolimus was 0.15 - 0.20 mg per kilogram of body weight per day. The data of the recovery of renal function, rejection episodes, incidences of side effect and related complication were analyzed respectively. RESULTS: The transplantation operations were performed uneventful in all the 23 recipients. There were no graft losses for technical reasons. The single graft failure was the result from bad compliance. The renal function was improved 5.5 days in average after transplantation in 22 cases. Main complications were arterial hypertension (57%), pulmonary infection (13%), drug-induced hepatic injury (13%) and bone marrow suppression (13%). Acute rejection occurred in 4 persons 1 year post-operatively (17%). The body weight of the recipients increased 2.3 kg in average and height increased 1.0 cm after the first post-operative year. The mean duration for follow-up was 42 month. One-year patient/graft survival rate was 100%/96% and three-year patient/graft survival rate was 90%/80%. CONCLUSION: Kidney transplantation is the preferred treatment for end stage renal failure in children patient. The well procedure, reasonable immunosuppressive regime, prevention and prompt therapy of complication are the keys to get satisfactory survival rate of human/kidney.