目的

总结终末期肾病儿童肾移植的临床特征及疗效。

方法

回顾性分析重庆医科大学附属儿童医院行肾移植的终末期肾病患儿临床资料,总结分析原发病、临床表现、透析情况、供肾特征、移植手术及随访情况等。观察患儿术后2周内移植肾功能动态变化及预后情况。

结果

共纳入儿童肾移植受者31例,男性15例、女性16例,中位年龄13.5岁；临床表现不典型,67.7%(21/31)患儿体型消瘦。原发病41.9%(13/31)为先天性泌尿系统发育异常,58.1%(18/31)为非尿路原发疾病。从确诊终末期肾病至肾移植手术中位等待时间为 10个月,54.8%(17/31)患儿术前行血液透析,32.3%术前行腹膜透析,仅12.9%(4/31)获得抢先肾移植。供肾中位热缺血时间6 min,中位冷缺血时间5 h,肾移植中位手术时间162.5 min。术后1、2、3、4 d达稳定状态透析肌酐水平的患儿比例分别为25.0%、59.3%、86.2%和92.0%,1周内多数患儿移植肾功能恢复接近正常。截至2024年8月,术后中位随访时间8个月。随访过程中发生移植肾失功2例,抗体介导急性排斥反应2例,新发BK病毒感染2例。

结论

终末期肾病患儿临床表现不典型,呈非特异性。儿童肾移植整体疗效好,大部分受者术后4天移植肾功能逐渐趋于稳定。

Objective

To summarize the clinical characteristics and efficacy of kidney transplantation in children with end-stage renal disease (ESRD).

Methods

The clinical features and follow-up results of children with ESRD after kidney transplantation in Children's Hospital of Chongqing Medical University were analyzed retrospectively. The primary diseases, clinical manifestations,dialysis state, donor features, operation and follow-up results were summarized and analyzed. The dynamic changes of renal allograft function within 2 weeks after operation and prognosis were observed.

Results

A total of 31 pediatric kidney transplantat recipients were included, 15 males and 16 females,with a median age of 13.5 years. The clinical presentation was atypical, and 67.7% (21/31) of the children were emaciated. The primary disease was primary urological abnormalities in 41.9% (13/31)and nonurological abnormalities in 58.1% (18/31). The median waiting time from the diagnosis of ESRD to renal transplantation was 10 months, and only 12.9% obtained preemptive renal transplantation. The median warm ischemia time of donor kidney was 6 min, the median cold ischemia time was 5 h, and the median operation time of renal transplantation was 162.5 min. Stable dialysis creatinine levels were achieved in 25.0%, 59.3%, 86.2%, and 92.0% of children at 1, 2, 3, and 4 days after surgery, respectively, and renal allograft function recovered close to normal in most children within 1 week. As of August 2024, the median postoperative follow-up time was 8 months. During follow-up, there were 2 cases of renal allograft failure, 2 cases of antibody-mediated acute rejection,and 2 cases of BK virus infection.

Conclusions

The clinical manifestations of children with ESRD are atypical and non-specific. The overall effect of pediatric kidney transplantation is promising, and most recipients gradually tend to have stable renal allograft function 4 days after surgery.