Clinical efficacy of en-bloc kidney transplantation from infantile donor organs to adult recipients: report of two cases
-
摘要:
目的 探讨婴幼儿公民逝世后器官捐献成人肾移植的临床效果。 方法 回顾性分析2例婴幼儿供肾成人肾移植的临床资料、手术方式、免疫抑制剂应用和随访情况并复习相关文献。 结果 1例男性受者原发病为慢性肾脏病变、肾衰竭, 术后移植肾功能恢复良好, 移植肾体积逐渐增大, 末次随访时(术后10个月)血清肌酐为84 μmol/L。另1例女性受者原发病为肾衰竭尿毒症期, 术后23 d死于心力衰竭合并严重肺部感染。2例受者均未发生血管并发症。 结论 婴幼儿捐献成人肾移植术后早期临床效果良好, 移植肾增长迅速。术中精细操作, 有利于预防供肾动脉血栓栓塞等并发症的发生。 Abstract:Objective To evaluate the clinical efficacy of en-bloc kidney transplantation from infantile organ donation after citizen's death to adult recipients. Methods Clinical data, surgical approach, use of immunosuppressive agents and follow-up of two adults undergoing kidney transplantation from infantile donor organs were retrospectively analyzed. Relevant literature review was performed. Results One male recipient was diagnosed with primary diseases of chronic renal lesions and renal failure. After kidney transplantation, the recipient obtained favorable recovery of kidney function. The grafted kidney was gradually increased in size. During the final follow-up (10 months after surgery), the serum creatinine level was measured as 84 μmol/L. The other female recipient was diagnosed with renal failure accompanied with uremia. The recipient died from heart failure complicated with severe pulmonary infection at postoperative 23 d. No vascular complications occurred in either recipient. Conclusions Kidney transplantation from infantile donor organs to adult recipients yields favorable clinical efficacy and the grafted kidney is significantly increased in size during the early stage. Precise intraoperative manipulation contributes to preventing the incidence of arterial embolism of the donor kidney and other postoperative complications. -
[1] Sui M, Zhao W, Chen Y, et al. Optimizing the utilization of kidneys from small pediatric deceased donors under 15 kg by choosing pediatric recipients[J]. Pediatr transplant, 2016, 20(1): 39-43. DOI: 10.1111/petr.12645. [2] 朱兰, 付程, 杜敦峰, 等.婴幼儿单供肾移植给成人受者的尝试与研究19例[J].中华器官移植杂志, 2016, 37(1):11-15. DOI: 10.3760/cma.j.issn.0254-1785.2016.01.003.Zhu L, Fu C, Du DF, et al. Single kidney transplantation from pediatric donors younger than 3 years to adult recipients[J]. Chin J Organ Transplant, 2016, 37(1): 11-15. DOI: 10.3760/cma.j.issn.0254-1785.2016.01.003. [3] Afanetti M, Niaudet P, Niel O, et al. Pediatric en bloc kidney transplantation into pediatric recipients: the French experience[J]. Pediatr Transplant, 2012, 16(2): 183-186. DOI: 10.1111/j.1399-3046.2012.01654.x. [4] Butani L, Troppmann C, Perez RV. Outcomes of children receiving en bloc renal transplants from small pediatric donors[J]. Pediatr Transplant, 2013, 17(1): 55-58. DOI: 10.1111/petr.12021. [5] Peng F, Yu S, Peng L, et al. Transplantation of en bloc kidneys from cardiac deceased small pediatric donors: 2 case reports and literature review[J]. Zhong Nan Da Xue Xue Bao Yi Xue Ban, 2014, 39(2): 204-208. DOI: 10.11817/j.issn.1672-7347.2014.02.017. [6] Hafner-Giessauf H, Mauric A, Müller H, et al. Long-term outcome of en bloc pediatric kidney transplantation in adult recipients -up to 22 years of center experience[J].Ann Transplant, 2013, 18: 101-107. DOI: 10.12659/AOT.883845. [7] Mwipatayi BP, Leong CW, Subramanian P, et al. En bloc kidney transplant from an 18-month-old donor to an adult recipient: case report and literature review[J]. Int J Surg Case Rep, 2013, 4(11): 948-951. DOI: 10.1016/j.ijscr.2013.08.006. [8] 朱有华, 曾力.我国儿童肾移植的现状与展望[J].武汉大学学报(医学版), 2016, 37(4): 603-606. DOI: 10.14188/j.1671-8852.2016.04.021.Zhu YH, Zeng L. History and outlook of pediatric renal transplantation in China[J]. Med J Wuhan Univ, 2016, 37(4): 603-606. DOI: 10.14188/j.1671-8852.2016.04.021. [9] Li JF, Liu J, Guo T, et al. Kidney transplantation from pediatric donors in a single Chinese center[J]. Cell Biochem Biophys, 2014, 70(3): 1713-1717. DOI: 10.1007/s12013-014-0118-y. [10] Chaudhuri A, Grimm P, Concepcion W. Small pediatric deceased donors for pediatric renal transplant recipients[J]. Pediatr transplant, 2016, 20(1): 7-10. DOI: 10.1111/petr.12646. [11] Maluf DG, Carrico RJ, Rosendale JD, et al. Optimizing recovery, utilization and transplantation outcomes for kidneys from small, ≤20 kg, pediatric donors[J].Am J Transplant, 2013, 13(10): 2703-2712.DOI: 10.1111/ajt.12410. [12] Kayler LK, Zendejas I, Gregg A, et al. Kidney transplantation from small pediatric donors: does recipient body mass index matter?[J]. Transplantation, 2012, 93(4): 430-436. DOI: 10.1097/TP.0b013e318241d57d. [13] Xue W, Tian P, Xiang H, et al. Outcomes for primary kidney transplantation from donation after citizens' death in China: a single center experience of 367 cases[J]. BMC Health Serv Res, 2017, 17(1): 250. DOI: 10.1186/s12913-017-2190-7. [14] Bent C, Fananapazir G, Tse G, et al. Graft arterial stenosis in kidney en bloc grafts from very small pediatric donors: incidence, timing, and role of ultrasound in screening[J].Am J Transplant, 2015, 15(11): 2940-2946. DOI: 10.1111/ajt.13365. [15] 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. [16] Zhu X, Liu H, Wang W, et al. Two cases of transplant renal artery thrombosis and spontaneous rupture caused by mucormycosis[J]. Transpl Infect Dis, 2015, 17(3):442-448. DOI: 10.1111/tid.12387. [17] Moreno de la Higuera Díaz MA, Calvo Romero N, Pérez-Flores I, et al. Surgical complications in en bloc renal transplantation[J]. Transplant Proc, 2016, 48(9): 2953-2955. DOI: 10.1016/j.transproceed.2016.09.014. [18] Jain V, Jain S, Singhal P, et al. Surgical illustration of en-bloc (dual) kidney transplant from a 16-month old brain-dead donor to an adult recipient[J]. Indian J Urol, 2017, 33(1): 85-89. DOI: 10.4103/0970-1591.194788.
点击查看大图
计量
- 文章访问数: 127
- HTML全文浏览量: 78
- PDF下载量: 7
- 被引次数: 0