| Background Chronic glomerulonephritis is still the main cause of children with uremia.Since first pediatric renal transplantation was performed in the United States in the 1960 s,and with the improvement of surgical technique,the application of new type of immunosuppressant,kidney transplantation has become the first choice of treatment for children with end-stage renal disease(end stage renal disease,ESRD).However,a significant proportion of children with uremia have not received renal replacement therapy for various reasons and have fewer recipients with kidney transplatation.In addition,it is more difficult to operate children with small size and small blood vessels,the immune system is underdeveloped and the medication is more complicated,especially the shortage of donor kidneys has limited the number of centers engaged in children's kidney transplantation in China,limited the number of transplants,and limited reports on the effects of children's kidney transplantation.In recent years,with the change of renal system and the principle of "child first" as in the United States,there a growing number of children receiving transplants.We summarize the 132 cases of kidney transplantation in the first affiliated hospital of zhengzhou university from August 2008 to September of 2017,and provide transplantation experience for pediatric renal transplantation.Although foreign reports on the recent effects of kidney transplantation in children are good,there are few reports on the long-term survival rate,transplantation effect,adverse events and growth and development of children with renal transplantation.In this study,53 children were followed up for 3 years until September 2017.We retrospectively summarized the postoperative long-dated effect,to support children's kidney transplantation as a treatment for end-stage renal disease preferred scheme is safe and reliable and provide theoretical support for expanding children's kidney transplant.On the other hand,as mentioned earlier,with the new organ donation and reference to the transplantation of "children first" system development in the United States,children donor has become an important part of the organ donation,it also makes the organ donation pool has been effectively expand,more and more got transplantation to treat patients with end-stage renal disease.For those who are more than 15 kg and older than 5 years of age,they are more likely to give two recipients at home and abroad.A considerable number of studies have been reported,this article will not go into detail.However,for the children under 15 kg weight and under 2 years of age,there is a considerable amount of waste of donor kidneys that are not fully utilized.For this type of donor individual effective renal units is not enough,to make up for the defects,clinical often use two kidney transplant as a whole to a receptor,but the difficul toperation,high filtration damage and thrombosis complications make a lot of transplant centers reluctant to try this kind of surgery.Only a small number of publications have reported cases of children with bilateral donor kidneys in one recipient,while cases of infants with bilateral donor kidneys in children are more rare.The present study also summarized 9 cases who had received double kidney transplantation of donors under 15 kg weight and under 2 years old in our center so far,the purpose of this study is to try the application of low age and low weight donor kidney in kidney transplantation,and to provide experience for the whole kidney transplantation in infants.Chapter 1 Clinical analysis of pediatric renal transplantation for donor kidney of children cardiac death organ donation Objective To explore the recent clinical effect of kidney transplantation in children.Data of 132 children receiving kidney transplantation from the department of kidney transplantation,the first affiliated hospital of zhengzhou university from August 2008 to September 2017 were retrospectively analyzed,record recipients before and after surgery of the change of serum creatinine and graft size,and adverse events.MethodsResults There were 21 cases of relatives,60 cases of donated after the death of the citizen,and 9 others.Age 13.2±7.3(25 days~44 years old)years,weight 34.2±11.9(2.5~75.6)kg;132 patients,age 12.1±4.2(4~18)years.Weight 34.8±14.1(10.7~56.9)kg.After 1 year of follow-up,the blood creatinine was reduced from the preoperative(894.3±282.1)umol/L to the postoperative(77.1±19.4)umol/L(P<0.05).The length of the transplanted kidney was increased from(56.4±19.3)mm before surgery(101.2±19.2)mm(P<0.05).The incidence of acute rejection was 8.3%(11/132),which in turn gave methylprednisolone 0.25 g /d,0.12 g/d,0.08g/d shock treatment for 3 d,and 10 cases were reversed after treatment,and 1 patient underwent nephrectomy due to kidney failure.The hyperacute rejection rate was 1.5%(2/132),and the nephrectomy was performed during the transplantation and at 2 days after surgery.Two patients underwent renal transplantation failure at 6 months and 8 months after surgery and restore hemodialysis.The incidence of DGF was 12.1%(16/132),and the dosage of immunosuppressive agents was adjusted,and the renal function of the children gradually returned to normal.In 10 patients,urinary leakage occurred,recoveryed after left the catheter and improved the nutrition.The incidence of infection was 12.9%(17/132),among which 15 cases of pulmonary infection were affected by anti-infective and immunological inhibition,and 12 cases of infective infection were controlled,and the patient was discharged from the hospital,and 3 children died of respiratory failure.Two cases of urinary tract infection were controlled by the application of sensitive antibiotics.A total of 6 patients died in 1 year follow-up,and 3 others died from pulmonary embolism,severe hepatitis and multiple organ failure.The survival rate was 95.5% / 91.7% in 5 cases of graft failure.Conclusion Children kidney transplantation has good clinical effect recently.Chapter 2 Long-term effects of kidney transplantation in children Objective To explore the long-term clinical effect of kidney transplantation in children.Method As of September,2017,there were 53 cases with a total of 53 cases,and 47 patients survived.The clinical data of patients were retrospectively analyzed,including surgical methods,immunosuppression,renal function,complications,recurrence of primary nephropathy,human kidney survival,education employment,and growth and development status.According to the three years after renal transplantation,e GFR was divided into two groups(n=41)and B(e GFR<90ml/min/ 1.73m2)(n=6),and the influence factors of e GFR were analyzed.Result There were 19 cases of living donor,17 cases of organ donors after death,and 6 others.The 53 patients were followed up for 3~9 years.The level of blood creatinine was decreased from the preoperative(820.1±323.1)?mol/L to 3 years after the operation(51.6±24.9)?mol/L(P<0.05).e GFR was increased to 3 years after the operation(103.5±11.4)ml/min/1.73m2 from the preoperative(17.1±7.8)ml/min/1.73m2(P<0.05).Transplant recipients age,preoperative dialysis time,number of HLA mismatching and postoperative delayed graft function healing(DGF),rejection and infection in six factors are the influence factors of e GFR to 3 years postoperatively(P<0.05),multi-factor binary logistic regression equation analysis showed that only rejection is a risk factor for 3 years postoperatively e GFR.Postoperative DGF 8 cases(8/53,15.1%)were recovered rapidly.There were 6 cases of acute rejection(6/47,12.8%)and 1 case of chronic rejection(1/47,2.1%).There were 9 cases of infection(9/47,19.1%).There were 6 cases of recurrence after surgery.The survival rate was 94.3%(50/53)and 88.7%(47/53).The average height of the patients in the first,second and third years after the surgery(4.6±1.9)cm(0.5~19.1 cm),(3.7±1.8)cm(0.7~14.3 cm)and(2.8±1.2)cm(0.3~8.7 cm).Conclusion The long-term effect of children kidney transplantation is good.Chapter 3 Clinical efficacy of en bloc kidney transplantation from pediatric donor kidneys Objection To evaluate the clinical efficacy of en bloc kidney transplantation from pediatric kidney organ donation after death.Methods The clinical data of 9 patients with donor kidney transplantation were analyzed retrospectively from April 2014 to November 2016 in the First Affiliated Hospital of Zhengzhou University.Follow up for 1 year,The levels of serum creatinine,blood urea nitrogen and transplanted kidney were recorded at 1 week,1 month,3 months,6 months,1 year,count the incidence of rejection,infection,urinary obstruction,urinary fistula,vascular embolization,vascular stenosis and other adverse events and 1 year human/kidney survival rate.Results After 1 year of follow-up,the survival rate was 88.9%/72%.The serum creatinine(Scr)level by preoperative(747.3±169.8)?mol/L fell to(83.2±37.4)mmol/L,blood urea nitrogen by preoperative(24.5±4.9)mmol/L fell to a tendency for L(6.8±2.0)mmol/L,graft length by preoperative(61.1±9.8)mm up to(100.3±1.7)mm.Postoperative DGF 2 cases were postoperatively restored after the transition of hemodialysis;Two cases of acute rejection occurred and reversed after treatment with methylprednisolone.1 case of pulmonary fungus infection occurred 2 weeks after surgery,the immunosuppressive agent was stopped,and antibacterial treatment was performed,but the effect was not good,and died 3 months after the operation.In 1 case,the renal artery thrombosis was formed after 7 days after surgery,and 10 d after surgery,resection was performed,and hemodialysis was restored.One patient had a renal artery embolization 1 month after the operation,and the remaining renal function was normal,and the growth was obvious 6 months after the operation.In addition,two cases of renal ureteral stenosis,2 cases of proteinuria,1 case of abdominal aortic stenosis and 1 case of urinary fistula were cured or improved after treatment.Conclusion The effect of en bloc kidney transplantation from pediatric donor is effective,but there are more complications during perioperative period,and the effect is gradually increased with the gradual accumulation of experience.Summary This study showed that: 1.Children kidney transplantation has good clinical effects in the near and long term,and renal transplantation can be the preferred treatment for children's end-stage renal disease.2.Children's kidney transplantation has effectively improved the survival quality and growth and development of the patients,providing a theoretical basis for the acceptance of renal transplantation in children.3.There are many complications during the perioperative period of kidney transplantation with double kidney,but as the experience gradually accumulates,the effect of the transplantation of kidney-kidney transplantation is gradually improving. |
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