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目的:总结婴幼儿公民逝世后器官捐赠(DCD)来源单侧供肾成人肾移植的临床效果。方法:回顾分析26例婴幼儿DCD供肾用于成人单侧肾移植的临床资料。分析受者术后血肌酐、表皮生长因子受体(e GFR)、移植肾长径的变化情况;1年内人/肾存活率;术后并发症等。结果 :婴幼儿供者年龄为8个月~5岁,并获取的26个肾脏均以单肾移植入成人受者体内,术后1年内e GFR由(27.80±15.27)[m L/(min·1.73 m~2)]增高至(67.76±10.48)[m L/(min·1.73 m~2)];术后1年内肾脏长径由(7.52±0.39)cm增长至(11.17±1.12)cm;术后1年人/肾存活率为100%/92.3%。发生移植肾功能恢复延迟(DGF)5例(19.23%);术后发生移植肾动脉瘤1例(3.85%),予介入动脉扩张和支架植入治疗无效予以切除肾脏;尿漏1例(3.85%),保守治疗无效予开腹探查并放置双J管后治愈;肺部感染4例(15.38%),1例为细菌感染,予抗感染治疗后好转,3例为真菌感染,但未需行呼吸机辅助治疗,均予抗真菌治疗后好转;其余受者至今未见明显异常。结论:婴幼儿是DCD的重要潜在捐赠者,通过严格维护供体及器官的质量,结合良好的手术技巧与完善的术后管理等,是可以实现婴幼儿供肾成人单肾移植的。
OBJECTIVE: To summarize the clinical outcomes of adult kidney transplant recipients from donor donors (DCDs) after the death of infants and children. Methods: A retrospective analysis of 26 cases of infant DCD donor kidney for adult unilateral kidney transplantation clinical data. Analysis of the postoperative serum creatinine, epidermal growth factor receptor (e GFR), the diameter of the transplanted kidney changes; 1 year of human / kidney survival rate; postoperative complications. Results: The age of infants and young donors was 8 months to 5 years old, and all the 26 kidneys obtained were transplanted into adult recipients by single kidney transplantation. The e GFR within one year after operation was (27.80 ± 15.27) [m L / (min (1.73 m 2)] to (67.76 ± 10.48) m L / (min 1.73 m 2). The diameter of the kidney increased from (7.52 ± 0.39) cm to (11.17 ± 1.12) cm ; 1 year postoperative human / kidney survival rate was 100% / 92.3%. 5 cases (19.23%) had delayed graft recovery (DGF), 1 case (3.85%) had renal artery aneurysm after transplantation, the renal artery was excised by interventional artery dilatation and stent implantation, 1 case (3.85% %), Conservative treatment ineffective to open exploration and double J tube placed after the cure; pulmonary infection in 4 cases (15.38%), 1 case of bacterial infection, to improve after treatment of infection, 3 cases of fungal infections, but not Line ventilator-assisted therapy, were anti-fungal treatment improved; the remaining recipients so far no obvious abnormalities. Conclusion: Infants and young children are important potential donors of DCD. By strictly maintaining the quality of donor and organ, combined with good surgical skills and perfect postoperative management, infants and young children can achieve single renal transplantation in infants and young children.