A Clinical Study On Single Kidney Transplantation From Deceased Juvenile Donors:(86 Cases Reports)

Objective: To explore the experience of perioperative management, clinical effect and safety of single kidney transplantation from juvenile donors. Methods: A retrospective analysis of 28 cases of a solitary kidney transplantation from juveniles donors in our hospital from 2007 December to 2015 August. Donors: 23 cases of donor male, 22 cases of donor female. The range of age was 8 month year to 18 years(the median age: 9.54±6.13). Kidneys of donor were obtained by open operation of abdominal multiple organ removals. Recipients: The median age of recipients was 33.79±10.81, 86 cases recipients were adults. The operation of renal arterial anastomosis: end-to-side anastomosis of donor renal artery and recipient arteriae iliaca externa. The operation of renal vein anastomosis: end-to-side anastomosis of donor vena cava and vena iliaca externa. The immunosuppression of recipients were induced by monoclone antibody CD25 in preoperative and postoperative, and were treated by improved triple immunosuppressive regimen(FK506+ MMF+ Pred or CsA+ MMF+ Pred), in additional, FK506 or CsA were proper administration of delay and reduced dosage, we according recipients CYP3A5 gene type, concentration of tacrolimus drug and T cell subgroup results to adjust the dose of immunosuppressant. According to TEG and activated clotting times of recipients adjust the anticoagulants treatment. Results: The success rate of operation is 100%. The postoperative complications as fellows: acute rejection of recipients: 14 cases(16.2%), drug poisoning: 10 cases(11.62%), DGF: 21 cases(24.44%), leakage of urine: 4 cases(4.65%), pulmonary infection: 7 cases(8.14%); 2 recipients died on postoperative day 15. 34 cases of recipients(39.52%) had no any postoperative complications. There are two cases of recipients(donor age for 11 and 15 months) in arterial embolism. Conclusions: The function protect system of donor organ has been established and applied to ensure the hemoperfusion and oxygen exchange of the organ, to help the rapid postoperative recovery of kidney transplanted. The improvement of surgical methods and protection of vessel endothelium can control the risk of postoperative complication of vessels efficiently. Anticoagulation scheme made with TEG and coagulation inspection and a good anticoagulant therapy can also minimize the rate of postoperative artery and venous embolism. A juvenile donor should be more than 2 years old and have a weight of more than 15 kg, with the kidney length of more than 6 cm. With a strict selection, the organ from a juvenile donor can be safe and practicable.