Shi Xiaofeng,Du Qing,Tu Jinpeng,et al.Clinical outcomes of pediatric en bloc kidney transplantation[J].Journal of Clinical Pediatric Surgery,2022,21(10):974-979.[doi:10.3760/cma.j.cn101785-202202044-013]
小儿双供肾整体移植的临床疗效分析
- Title:
- Clinical outcomes of pediatric en bloc kidney transplantation
- Keywords:
- En Bloc Kidney Transplantation (EBKT); Complications; Proteinuria; Pediatric Donor; Single-Kidney Transplantation (SKT)
- 摘要:
- 目的 总结和分析小儿双供肾整体移植的临床疗效,并探讨经验和教训。方法 回顾性分析天津市第一中心医院肾移植科2011年7月至2022年1月收治的36例小儿双供肾整体移植患者的临床资料。主要观察移植肾存活率、移植肾丢失以及泌尿系统并发症发生率,还包括蛋白尿,出血等。随访3年,观察患者生存率及血清肌酐变化。结果 术后1年、3年的移植物存活率均为83%(30/36),移植受者存活率均为100%(36/36),移植物长期存活的30例受者中,术后3年血肌酐水平持续下降。移植肾丢失发生率为16.7%(6/36),其他并发症包括泌尿系统并发症16.7%(6/36)、出血11.1%(4/36)等。蛋白尿的发生比例逐步下降,大部分在随访期间消失。结论 小儿双供肾整体移植具有良好的长期移植肾功能和存活率,是一个增加供体库的可行、有效方法。
- Abstract:
- Objective To summarize the clinical outcomes of en bloc kidney transplantation (EBKT) from pediatric donors at a single center and summarize the experiences and lessons.Methods Thirty-six pediatric to adult EBKTs were performed between July 2011 and February 2022.The primary outcome variable was en-bloc allograft survival rate.Secondary outcome variables included incidence of graft failure and incidence of urological complications.The postoperative occurrences of such complications as proteinuria and hemorrhage were recorded along with overall survival and serum creatinine during 3-year follow-ups.Results Both 1/3-year graft survival rates were 83%(30/36) and the recipient survival rate was 100%(36/36).And 30 recipients achieved long-term graft survival.Improvement of creatinine level was noted up until the third year.Graft failure was a serious posttransplant complication with an incidence of 16.7%(6/36).Other complications included urological complications (16.7%,6/36) and hemorrhage (11.1%,4/36).The percentage of patients with proteinuria declined gradually and proteinuria subsided largely during follow-ups.Conclusion EBKT from pediatric donors is associated with excellent long-term allograft and patient survivals.It is a feasible strategy of expanding the transplant donor pool.
参考文献/References:
[1] Israni AK,Zaun D,Rosendale JD,et al.OPTN/SRTR 2019 annual data report:deceased organ donors[J].Am J Transplant,2021,21(Suppl 2):521-558.DOI:10.1111/ajt.16491.
[2] Damji S,Callaghan CJ,Loukopoulos I,et al.Utilisation of small paediatric donor kidneys for transplantation[J].Pediatr Nephrol,2019,34(10):1717-1726.DOI:10.1007/s00467-018-4073-5.
[3] Meakins JL,Smith EJ,Alexander JW.En bloc transplantation of both kidneys from pediatric donors into adult patients[J].Surgery,1972,71(1):72-75.
[4] Suneja M,Kuppachi S,Katz D,et al.Small split pediatric kidneys to expand the donor pool:an analysis of scientific registry of transplant recipients (SRTR) data[J].Transplantation,2019,103(12):2549-2557.DOI:10.1097/TP.0000000000002706.
[5] Rogers J,Farney AC,Orlando G,et al.Dual kidney transplantation from donors at the extremes of age[J].J Am Coll Surg,2019,228(4):690-705.DOI:10.1016/j.jamcollsurg.2018.12.021.
[6] Das DM,Heilman RL,Khamash HA,et al.Overcoming mismatch concerns for adult recipients of small pediatric deceased donor kidneys[J].Transplant Proc,2021,53(5):1509-1513.DOI:10.1016/j.transproceed.2021.03.030.
[7] Sureshkumar KK,Habbach A,Tang A,et al.Long-term outcomes of pediatric en bloc compared to living donor kidney transplantation:a single-center experience with 25 years follow-Up[J].Transplantation,2018,102(5):e245-e248.DOI:10.1097/TP.0000000000002104.
[8] Hirukawa T,Suzuki H,Niimura F,et al.En bloc cadaver kidney transplantation from a 9-month-old donor to an adult recipient:maturation of glomerular size and podocyte in the recipient[J].Transplant Direct,2017,3(3):e130.DOI:10.1097/TXD.0000000000000648.
[9] Damji S,Callaghan CJ,Loukopoulos I,et al.Utilisation of small paediatric donor kidneys for transplantation[J].Pediatr Nephrol,2019,34(10):1717-1726.DOI:10.1007/s00467-018-4073-5.
[10] Sampaio MS,Lum EL,Homkrailas P,et al.Outcomes of small pediatric donor kidney transplants according to donor weight[J].Transpl Int,2021,34(11):2403-2412.DOI:10.1111/tri.14026.
[11] Al-Shraideh Y,Farooq U,El-Hennawy H,et al.Single vs dual (en bloc) kidney transplants from donors ≤ 5 years of age:A single-center experience[J].World J Transplant,2016,6(1):239-248.DOI:10.5500/wjt.v6.i1.239.
[12] Troppmann C,Santhanakrishnan C,Fananapazir G,et al.Pediatric en bloc kidney transplantation from very small (≤ 10 kg) donation after circulatory death (versus brain death) donors:Single-center matched-pair analysis of 130 transplants[J].Am J Transplant,2018,18(11):2811-2817.DOI:10.1111/ajt.14914.
[13] Zi?tek Z.Endothelial Markers:Thrombomodulin and Von Willebrand factor and risk of kidney thrombosis after transplantation[J].Transplant Proc,2021,53(5):1562-1569.DOI:10.1016/j.transproceed.2021.03.011.
[14] Wang CS,Greenbaum LA,Patzer RE,et al.Renal allograft loss due to renal vascular thrombosis in the US pediatric renal transplantation[J].Pediatr Nephrol,2019,34(9):1545-1555.DOI:10.1007/s00467-019-04264-0.
[15] Kanzelmeyer NK,Lerch C,Ahlenstiel-Grunow T,et al.The role of protocol biopsies after pediatric kidney transplantation[J].Medicine (Baltimore),2020,99(23):e20522.DOI:10.1097/MD.0000000000020522.
[16] Bhayana S,Kuo YF,Madan P,et al.Pediatric en bloc kidney transplantation to adult recipients:more than suboptimal[J]?Transplantation.2010 Aug 15;90(3):248-254.DOI:10.1097/TP.0b013e3181e641f8.
[17] Mitrou N,Aquil S,Dion M,et al.Transplantation of pediatric renal allografts from donors less than 10 kg[J].Am J Transplant,2018,18(11):2689-2694.DOI:10.1111/ajt.14946.
[18] 杨吉刚,王巍.核医学肾脏显像对儿童肾积水患者分肾功能的评估价值[J].临床小儿外科杂志,2021,20(4):307-311.DOI:10.12260/lcxewkzz.2021.04.002. Yang JG,Wang W.Value of nuclear medicine renal imaging in the assessment of renal function in pediatric hydronephrosis[J].J Clin Ped Sur,2021,20(4):307-311.DOI:10.12260/lcxewkzz.2021.04.002.
[19] Kayler LK,Zendejas I,Gregg A,et al.Kidney transplantation from small pediatric donors:does recipient body mass index matter[J]?Transplantation.2012 Feb 27;93(4):430-436. DOI:10.1097/TP.0b013e318241d57d.
[20] Chen C,Su X,Wu C,et al.Successful single kidney transplantation from pediatric donors less than or equal to 10 kg to adult recipient:a retrospective cohort study[J].Transl Pediatr,2021,10(6):1618-1629.DOI:10.21037/tp-21-23.
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备注/Memo
收稿日期:2022-2-21。
基金项目:天津市卫生健康委员会科技项目(KJ20128、KJ20122、KJ20111、ZC20227、KJ20090)
通讯作者:莫春柏,Email:mochunbaitj@126.com