CAJ | 학술논문

目的探讨心脏死亡供者供肾儿童肾移植的临床效果.方法供者为男性,年龄49岁,属“中国心脏死亡器官捐献分类标准”中的中国三类；受者为男性,14岁,原发病为肾病综合征、慢性肾功能衰竭.取供者右侧肾脏作为供肾,供肾动、静脉分别与受者髂总动脉、静脉行端侧吻合,移植肾输尿管内置带线双J管后与受者膀胱行隧道式包埋手术,将移植肾放置于受者右侧髂窝上方腹膜后腔.供肾热缺血时间为12 min,冷缺血时间为2h.使用巴利昔单抗和甲泼尼龙行免疫诱导治疗,术后采用他克莫司+吗替麦考酚酯+甲泼尼龙的三联免疫抑制方案.结果术后1d时,受者出现ALT急剧升高,诊断为急性药物性肝损害,给予保肝降酶治疗后,ALT降至正常；术后3d时,受者出现腹部肠道不完全梗阻症状,经积极对症处理后症状消失,未发生急性排斥反应及移植肾功能恢复延迟等并发症.术后1个月时,受者顺利出院,至今随访6个月,移植肾功能正常.结论心脏死亡供者供肾儿童肾移植手术安全、有效,但远期效果需要进一步观察.
목적 탐토심장사망공자공신인동신이식적림상효과.방법 공자위남성,년령49세,속“중국심장사망기관연헌분류표준”중적중국삼류；수자위남성,14세,원발병위신병종합정、만성신공능쇠갈.취공자우측신장작위공신,공신동、정맥분별여수자가총동맥、정맥행단측문합,이식신수뇨관내치대선쌍J관후여수자방광행수도식포매수술,장이식신방치우수자우측가와상방복막후강.공신열결혈시간위12 min,랭결혈시간위2h.사용파리석단항화갑발니룡행면역유도치료,술후채용타극막사+마체맥고분지+갑발니룡적삼련면역억제방안.결과 술후1d시,수자출현ALT급극승고,진단위급성약물성간손해,급여보간강매치료후,ALT강지정상；술후3d시,수자출현복부장도불완전경조증상,경적겁대증처리후증상소실,미발생급성배척반응급이식신공능회복연지등병발증.술후1개월시,수자순리출원,지금수방6개월,이식신공능정상.결론 심장사망공자공신인동신이식수술안전、유효,단원기효과수요진일보관찰.
Objective To evaluate the effect of pediatric renal transplantation using donation after cardiac death (DCD).Methods The male DCD meeting Chinese standard Ⅲ (C-Ⅲ) was 49 years old,and the recipient with chronic renal failure was 14 years old.The right kidney of the donor was transplanted to the recipient.The renal artery and renal vein of the donor were end-to-side anastomoscd to the common iliac artery and common iliac vein of the recipient,respectively.The graft was transplanted into the fight iliac fosse.Warm ischemia time was 12 min,and cold ischemia time was 2 h.Immunity induction therapy was performed with basiliximab.Tacrolimus + mycophnolate mofetil + Pred were used as immunosuppressive regimen.Results The transplantation was done successfully.One day after operation,ALT was increased dramatically.The recipient was diagnosed as acute drug-induced liver injury.There was no occurrence of acute rejection and delayed graft function.The recipient was discharged one month after the operation,and followed up for 6 months with normal graft function.Conclusion Pediatric renal transplantation using DCD is effective and safe,even though the long-term effect still needs to be further observed.