| BackgroundSince early 2015 of a total ban organ transplant organs from executed prisoners, so after the death of citizens organ donation (donation after citizen death, DCD) has become the main source of the donor kidney. As the infant casualty rate is higher, and social relations is relatively simple, so the infant’s death organ donation citizens for expanding donor kidney source of great significance. However, the infant kidney (especially unilateral donor kidney) for adult kidney transplant screening is particularly strict conditions, may be due to lack of donor renal units and other high incidence of complications of vascular problems affecting transplantation, most transplant Center for infants and young children use the block kidney or renal transplantation formula [2]. If the block is divided into two kidney transplant two adults, which is the source of pressure to ease kidney is important, currently there are many centers for infants with unilateral renal transplantation in adult patients to get good results. Thus, in order to reduce the sources of tension in the body organ transplant issue for our hospital transplant center retrospective analysis of 24 cases of infants with clinical unilateral between January 2013 to March 2015 at the Centre for the implementation of adult kidney transplant patients to information, in order to evaluate the effect of after transplantation.Objective:Assessment of underweight children DCD (citizens of organ donation after death) donor kidney with unilateral early safety and clinical effects of adult kidney transplant can be used.Methods:Retrospective analysis of our hospital from January 2013 to March 2015 line of children for renal adult kidney transplantation in 24 patients (children’s donor kidney group), with the same period the adult donor kidney adult renal transplantation 62 cases (adult donor kidney group) clinical data. Analysis of two recipients in serum creatinine, changes in eGFR, kidney transplant long diameter, urine protein incidence of postoperative complications, and 6 months,1 year patient /graft survival rate and so on.Results:(1) donor age children 8 months to 4 years old,24 are single kidney and acquired renal transplant recipient in vivo into adulthood, the child donor kidney group after 7d,1 month,3 months,6 month and 1-year serum creatinine were (293.89 ± 179.73), (240.88 ± 214.48), (155.93 ± 20.38), (120.09 ± 20.38) and (114.44 ± 14.28) mol/L; children for renal blood group 7d and January creatinine levels were significantly higher than those for adult kidney group, the difference was not statistically significant (P<0.05); and in March, June, no significant difference (P and 1-year serum creatinine levels> 0.05);(2) Children’s donor kidney group after 7d,1 month,3 months,6 months and 1 year eGFR were (28.41 ± 15.47), (34.48 ± 13.29), (48.36 ± 10.84), (56.61 ± 8.43), (65.08 ± 9.63) [ml/(min · 1.73 m2)];Children kidney group 7d and January eGFR was significantly lower than for adult kidney group, the difference was not statistically significant (P<0.05); and March, no significant difference (P June and 1 year eGFR> 0.05).(3) children’s group the day of surgery for kidney after 1 week,2 weeks,3 weeks,4 weeks,2 months,3 months,6 months and 1 year color ultrasound examination measured under long diameter were transplanted kidney It was (6.77 ± 1.32), (7.59 ± 0.94), (8.40 ± 0.82), (8.52 ± 0.84), (8.77 ± 0.73), (9.80 ± 0.63), (9.60 ± 0.95), (10.53 ± 1.32), (11.08 ± 1.23) cm; children’s group the day of surgery for kidney after 1 week,2 weeks, three weeks, four weeks and two months long diameter graft donor kidney was significantly lower than the adult group, the difference was not statistically significant (P< 0.05); and in March, June and 1-year graft long diameter was no significant difference (P> 0.05). (Table 2-3, Fig.3)(4) for children with renal graft function recovery group had delayed five cases (20.83%); postoperative renal artery aneurysm in 1 case (4.17%), to intervene arteries and stent implantation ineffective treatment be excised kidney; acute rejection reaction 2 cases (8.33%), after I methylprednisolone pulse therapy, serum creatinine returned to normal; urinary leakage in 1 case (4.17%), after conservative treatment ineffective to laparotomy and left double-J tube to cure; pulmonary infection in 4 cases (16.67%),1 case of bacterial infection, to improve anti-infective therapy,3 cases of fungal infection, but did not need to line ventilator-assisted therapy, improved herein are antifungal therapy; two groups no significant difference in the incidence of complications (P> 0.05)(5) Children’s donor kidney group after 1 month,3 months,6 months and 1 year the incidence of urinary protein was 32.65%, respectively,37.45%,45.80% and 55.68%. The remaining recipients renal function recovered smoothly. Postoperative January, March and June, the incidence of urinary protein was no significant difference (P> 0.05); the incidence of urinary protein for children 1 year of renal group was significantly higher than the adult donor kidney group. (P<0.05)(6) Children’s donor kidney group after 6 months,1 year/graft survival rates were 100%/94.4%,100%/92.3%;Adult kidney group after 6 months,1 year/graft survival rates were 100%/100%,96.7%/91.9%, the difference was not statistically significant (P> 0.05).Conclusions:For infants and young children for themselves, as long as no obvious defects in kidney development, when donor kidney function was normal, it seems infant donor application no age limit [2]. Domestic Tongji Hospital, Huazhong University of Science and have tried to use-two days of birth 33 weeks, gestatianal age preterm children to 13 years for kidney transplant recipients for children, surgical results were satisfactory, and will be able to meet the physical needs of unilateral kidney recipients. May be due to the fetus after birth, the number side of the renal unit has reached adult levels, kidney transplant will need to adapt to physiological donors [4]. In other words, as long as reasonable prevention and treatment of postoperative complications, infant unilateral renal transplantation for adults seems no age limit. In fact the younger donor, transplant surgery difficult it becomes, the more prone to complications, the lower the success rate of transplantation. Now that the age of five than children with unilateral renal adult kidney transplant is better [5,6], the Centre included under the age of 5 are donors, recipients are adults, surgical methods are unilateral renal transplantation, recipient, eGFR at a low level in six months, but after June recipients eGFR almost reached adult levels. Similarly, after 6 months after Scr levels decreased to normal levels. Within 6 months after renal transplantation long diameter close to the adult level. Description With 5 years of age for infants with unilateral renal adult recipients as long as smoothly through the high incidence of surgical complications, postoperative renal function recovery is still better.Use of infant kidney early surgical complication rate is one of the main obstacles to transplant success rate, mainly affects infants and young children for complications of kidney transplant success rate of early vascular complications [7]. For example, renal artery and vein thrombosis, tumors and arteriovenous anastomotic stenosis. Its risk factors in addition to recipients hypercoagulable state, renal vascular spasm, an important reason for infants with renal vascular conditions are closely related. Because infants delicate kidneys and blood vessels in the organ procurement, and surgical correction process easy to damage the kidney vascular endothelium, plus fine for renal vascular caliber, all of these factors are leading to thrombosis and anastomotic stenosis. In addition, for most of the infant donor, in particular the age of five, mainly domestic center kidneys or the entire kidney transplant procedure, but its structure is more complex kidneys and blood vessels, kidneys and blood vessels adjust restricted easily vascular compression, angled and appear distorted. The Centre unilateral renal transplantation were selected, in addition to the advantage of lowering the difficulty of operation, its simple structure, placing the kidneys and blood vessels more flexible position. As the case may be appropriate to extend the use of arteriovenous graft renal artery and vein, kidneys and blood vessels is conducive to adjust the position. Also, avoid selecting arteriovenous malformation of kidney, try to use a single arteriovenous kidneys. Finally, when the vascular anastomosis, anastomosis is large enough to ensure the use of a wide sheet to avoid abdominal aortic anastomotic stenosis and occlusion when necessary. Postoperative use of warfarin therapy, the maintenance of international normalized ratio (INR) between 2 and 3, in the early postoperative need close monitoring of arterial and venous ultrasound blood flow. The Centre had no recipient occurs arteriovenous thrombosis and anastomotic strictures, moving lower incidence of venous aneurysm.Use another important issue for infants kidney ultrafiltration through injury. Some scholars believe that the incidence of children for three years after renal transplantation proteinuria was significantly higher than the adult donor kidney group. For infants younger donors, using the formula renal transplantation is still the main way to avoid the ultrafiltration through injury. It is generally believed, younger than 5 years old donor, we should adopt the kidneys or the entire kidney transplantation. However, the current shortage of organs, even for those younger than 5 years old, single kidney transplantation is also recommended for inclusion choose surgical areas. Therefore, in order to maximize the number of units to avoid kidney loss, we have taken a series of measures to achieve the potential donor quickly correct the imbalance in the environment donor, using a variety of methods such as kidney quick access method for kidney preservation in situ France, extracorporeal membrane oxygenation oxygenation, chest compressions automatic method and machine perfusion of organs to ensure quality [9], as far as possible the various factors that affect organ function and minimize minimum. In addition, due to the low level of blood pressure in infants, infant kidneys can tolerate lower blood pressure, so the early postoperative use of antihypertensive drugs to maintain systolic blood pressure between 110～130 mmHg, the younger the donor blood pressure should be controlled the more stringent, as soon as possible after the addition of oral antihypertensive drugs.The results of this study suggest that choose single arteriovenous graft, using a variety of measures to protect the number of nephrons, postoperative use various means prevention and treatment of vascular complications, as long as smoothly through the high incidence of surgical complications, younger than 5 years of age for infants with unilateral renal transplantation for adults, still get better results. But long-term effects need to be further clinical validation studies. |
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