中华器官移植杂志
中華器官移植雜誌
중화기관이식잡지
CHINESE JOURNAL OF ORGAN TRANSPLANTATION
2014年
10期
594-598
,共5页
杨顺良%谭建明%吴志贤%郭君其%陶小琴%蔡锦全%陈小文%高霞
楊順良%譚建明%吳誌賢%郭君其%陶小琴%蔡錦全%陳小文%高霞
양순량%담건명%오지현%곽군기%도소금%채금전%진소문%고하
儿童%器官捐献%肾移植%死亡%肾功能
兒童%器官捐獻%腎移植%死亡%腎功能
인동%기관연헌%신이식%사망%신공능
Children%Organ donation%Kidney transplantation%Death%Renal function
目的 总结儿童心脏死亡器官捐赠来源单个供肾移植的临床效果与体会.方法 回顾分析5例儿童心脏死亡器官捐赠的实施流程与供肾移植资料.儿童捐赠者的年龄为4～9岁,原发病分别为心肺复苏后缺氧性脑损伤1例,重型颅脑外伤2例,脑恶性肿瘤2例.捐赠者中,中国三类4例,中国二类1例.原位灌注、肝肾联合切取获得肾脏10个.结果 供者4例行零点穿刺活组织病理学检查,其中1例局灶球性节段性足细胞肿胀、肾小管显著浊肿,肾间质水肿,另3例病理改变轻.获取的10个肾脏均植入受者体内,其中儿童受者3例,成人受者7例,受者体质量为35～69 kg,发生移植肾功能恢复延迟2例.术后半年移植肾长径由(7.74±0.68)cm增长为(10.46±0.19)cm.术后发生移植肾动脉狭窄1例,介入动脉扩张和支架植入治疗后痊愈.8例受者随访6个月以上,除1例血肌酐为133 μmol/L外,余均波动于正常范围内.随访截止时3例儿童受者肾小球滤过率分别为1.89ml/s、1.78 ml/s和1.06 ml/s,7例成人受者肾小球滤过率为0.82～1.34ml/s.所有受者均未发生严重肺部感染或尿路感染.结论 儿童是公民逝世后器官捐赠的重要潜在捐赠者,但需严格把握脑损伤程度的判断.大于7 cm的儿童供肾可行单个肾移植,良好的手术技巧与完善的术后管理等是确保移植成功的关键.
目的 總結兒童心髒死亡器官捐贈來源單箇供腎移植的臨床效果與體會.方法 迴顧分析5例兒童心髒死亡器官捐贈的實施流程與供腎移植資料.兒童捐贈者的年齡為4～9歲,原髮病分彆為心肺複囌後缺氧性腦損傷1例,重型顱腦外傷2例,腦噁性腫瘤2例.捐贈者中,中國三類4例,中國二類1例.原位灌註、肝腎聯閤切取穫得腎髒10箇.結果 供者4例行零點穿刺活組織病理學檢查,其中1例跼竈毬性節段性足細胞腫脹、腎小管顯著濁腫,腎間質水腫,另3例病理改變輕.穫取的10箇腎髒均植入受者體內,其中兒童受者3例,成人受者7例,受者體質量為35～69 kg,髮生移植腎功能恢複延遲2例.術後半年移植腎長徑由(7.74±0.68)cm增長為(10.46±0.19)cm.術後髮生移植腎動脈狹窄1例,介入動脈擴張和支架植入治療後痊愈.8例受者隨訪6箇月以上,除1例血肌酐為133 μmol/L外,餘均波動于正常範圍內.隨訪截止時3例兒童受者腎小毬濾過率分彆為1.89ml/s、1.78 ml/s和1.06 ml/s,7例成人受者腎小毬濾過率為0.82～1.34ml/s.所有受者均未髮生嚴重肺部感染或尿路感染.結論 兒童是公民逝世後器官捐贈的重要潛在捐贈者,但需嚴格把握腦損傷程度的判斷.大于7 cm的兒童供腎可行單箇腎移植,良好的手術技巧與完善的術後管理等是確保移植成功的關鍵.
목적 총결인동심장사망기관연증래원단개공신이식적림상효과여체회.방법 회고분석5례인동심장사망기관연증적실시류정여공신이식자료.인동연증자적년령위4～9세,원발병분별위심폐복소후결양성뇌손상1례,중형로뇌외상2례,뇌악성종류2례.연증자중,중국삼류4례,중국이류1례.원위관주、간신연합절취획득신장10개.결과 공자4례행영점천자활조직병이학검사,기중1례국조구성절단성족세포종창、신소관현저탁종,신간질수종,령3례병리개변경.획취적10개신장균식입수자체내,기중인동수자3례,성인수자7례,수자체질량위35～69 kg,발생이식신공능회복연지2례.술후반년이식신장경유(7.74±0.68)cm증장위(10.46±0.19)cm.술후발생이식신동맥협착1례,개입동맥확장화지가식입치료후전유.8례수자수방6개월이상,제1례혈기항위133 μmol/L외,여균파동우정상범위내.수방절지시3례인동수자신소구려과솔분별위1.89ml/s、1.78 ml/s화1.06 ml/s,7례성인수자신소구려과솔위0.82～1.34ml/s.소유수자균미발생엄중폐부감염혹뇨로감염.결론 인동시공민서세후기관연증적중요잠재연증자,단수엄격파악뇌손상정도적판단.대우7 cm적인동공신가행단개신이식,량호적수술기교여완선적술후관리등시학보이식성공적관건.
Objective To investigate the feasibility of pediatric organ donation after cardiac death (DCD) and summarize the clinical outcomes and the experience of transplantation of single pediatric kidney.Method A retrospective analysis of the data was done on the procedure of 5 cases of pediatric organ donation and transplant outcomes at our center.The donors were at age 4 to 9 with one case of cerebral hypoxia after cardiopulmonary resuscitation,two cases of severe traumatic brain injury and two cases of malignant brain tumors,respectively.Four cases were classed as category Ⅲ of China DCD Classification and one as category Ⅱ.Ten kidneys were recovered after in situ perfusion using liver-kidney en bloc resection.Result Zero biopsy was performed in four kidneys from four donors.Pathologically,one case had focal global and segmental podocyte injury with significant tubular cloudy swelling and interstitial edema,and three cases had mild pathological changes.Ten kidneys were all transplanted to 3 pediatric recipients and 7 adult ones.The recipients' weight was 35 to 69 kg.Delayed graft function occurred in two cases.Compensatory hypertrophy occurred in all kidneys with a length of 10.46 ± 0.19 cm at 6 months post-transplant from 7.74 ± 0.68 at baseline.Renal arterial stenosis was observed in one patient,who was cured with interventional balloon dilatation and stent implantation.Eight patients were followed up for ＞ 6 months with normal serum creatinine levels except for one of 133 μmol/L by the last visit.The eGFR levels were 1.87,1.78 and 1.06 ml/s in 3 children,respectively,and 0.82-1.34 ml/s in 7 adults.All recipients were not serious lung and urinary tract infection.Conclusion Pediatric DCD is a critical potential complement for organ pool and diagnostic criteria for cerebral lesions should be strictly adhered to.Single pediatric kidney transplantation with a length ＞ 7 cm is acceptable.Good surgical skills and comprehensive postoperative care are essential for successful pediatric kidney donation and transplantation.
