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目的评估体重<15kg的儿童DCD(公民逝世后器官捐献,包括脑死亡捐献和心脏死亡捐献)供者单侧供肾用于成人肾移植的早期安全性及临床效果。方法回顾分析本院2013年2月至2015年2月间行体重<15kg的儿童供肾成人肾移植18例(儿童供肾组),与同期成人供肾成人肾移植62例(成人供肾组)的临床资料,分析两组患者术后并发症;1个月、3个月、6个月及1年移植肾eGFR;术后6个月及1年人、移植肾存活率;儿童供肾组术后移植肾长径、eGFR的变化情况,蛋白尿、血尿发生情况。结果儿童供肾组DGF、AR、血管及泌尿系并发症发生率分别为22.22%、5.56%、5.56%和5.56%,成人供肾组为20.03%、3.26%、0%和0%(P均>0.05);所有受者观察期间均未死亡,术后1个月儿童供肾组eGFR明显低于成人供肾组(P<0.05),术后3个月、6个月及1年,两组eGFR无差异(P>0.05)。儿童供肾组术后6个月及1年移植物存活率分别为93.80%和93.80%,而成人供肾组为98.20%和98.20%(P>0.05);儿童供肾组移植肾eGFR、长径与术后时间呈正相关增长,观察期内儿童供肾组蛋白尿发生率与成人组相当,血尿发生率高于成人组。结论本组体重<15kg的儿童DCD单侧供肾成人肾移植术后并发症、功能(依据eGFR评价)与成人组相当,供肾长径及移植肾eGFR在术后3~6个月可增至成人水平,低体重儿童单侧供肾成人肾移植手术并发症率低,近期效果满意,远期效果有待进一步观察。
Objectives To assess the early safety and clinical outcomes of DCD (organ donation after death of a citizen, donation of cardiac death and cardiac death donation) in children with a body weight of <15 kg for single kidney transplantation in adult patients. Methods A retrospective analysis of 18 adult renal transplant recipients with children weighing <15 kg between February 2013 and February 2015 in our hospital was conducted, compared with 62 adult donors (adult donor kidneys) ). The clinical data of two groups were analyzed. The postoperative complications of the two groups were analyzed. The eGFR of 1, 3, 6 and 1 year, the survival rate of 6 months and 1 year after transplantation, Group length of renal transplant recipients, eGFR changes, proteinuria, hematuria. Results The incidences of DGF, AR, vascular complications and urinary complications in children with renal donors were 22.22%, 5.56%, 5.56% and 5.56%, 20.03%, 3.26%, 0% and 0% > 0.05). All the recipients did not die during the observation period. The eGFR of the kidneys donor group at 1 month after operation was significantly lower than that of the adult donor group (P <0.05). The eGFR at 3 months, 6 months and 1 year, Group eGFR no difference (P> 0.05). The survival rates of 6-month and 1-year graft-versus-kidneys were 93.80% and 93.80%, respectively, in adult donor kidneys and 98.20% and 98.20% in adult donor kidneys (P> 0.05) Pathology and postoperative time showed a positive correlation between the growth of children during the observation period of kidney proteinuria and adult group, the incidence of hematuria than adults. Conclusion The complication and function (based on eGFR evaluation) of adults with DCD unilateral donor kidney in children with body weight <15kg are comparable to those in adult group. The long diameter of donor kidney and eGFR of transplant recipients can be increased at 3-6 months after operation To the adult level, low birth weight children with unilateral renal transplantation for renal failure in children with low complication, the recent results are satisfactory, the long-term results need to be further observed.