Silvia Oberparleiter, Felix J Krendl, Thomas Resch, Rupert Oberhuber, Hannah Esser, Florian Ponholzer, Annemarie Weissenbacher, Robert Breitkopf, Hannes Neuwirt, Stefan Schneeberger, Manuel Maglione, Benno Cardini
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引用次数: 0
摘要
背景：脑死亡≤2年的儿童小供体肾脏仍被归类为边缘器官。在此，我们分析了从≤2年的儿童供体到成人受体的整体肾移植（EBKT）与标准标准供体肾移植受体（skt）的结果。方法：对2015年1月至2017年6月期间前瞻性收集和可审计的数据库进行回顾性单中心分析，确定了6例ebkt和75例skt。倾向得分匹配最小化选择偏差。结果：中位随访74个月后，EBKTs组5年患者和移植物存活率均为100%。在接受skt治疗后，5年患者生存率为94.7%，同样，死亡审查后的移植物生存率达到94.7%。2例EBKT患者发生单侧动脉移植血栓，需行单侧肾切除术，恢复完全，肾功能良好。出院时，与SKT相比，EBKTs接受者的eGFR下降，然而，从3个月开始，这种情况发生逆转，中位随访74个月后，EBKT后的中位eGFR是SKT的两倍（107 ml/min/1.73m2 vs. 52 ml/min/1.73m2）。结论：来自非常小的儿童供体的EBKTs显示出良好的长期肾功能。较高的术后并发症发生率并不意味着较差的中期患者和移植物生存。
En-bloc kidney transplants from very small pediatric donors: a propensity score matched analysis.
Background: Kidneys from brain-death small pediatric donors ≤2 years are still classified as marginal organs. Herein, we analyse the outcomes following en-bloc kidney transplantation (EBKT) from pediatric donors ≤2 years into adult recipients compared to standard criteria donor kidney transplant recipients (SKTs).
Methods: A retrospective single center analysis of a prospectively collected and auditable database identified six EBKTs and 75 SKTs between January 2015 and June 2017. Propensity score matching minimized selection bias.
Results: After a median follow-up of 74 months, five-year patient and graft survival were 100%, each in the EBKTs group. Following SKTs, the five-year patient survival rate was 94.7%, likewise death-censored graft survival reached 94.7%. Two EBKT cases experienced unilateral arterial graft thrombosis requiring unilateral nephrectomy, with full recovery and good kidney function. At hospital discharge, recipients of EBKTs showed decreased eGFR compared to SKTs, however, from 3 months onward this reversed and following a median follow-up of 74 months the median eGFR was twice as high after EBKT compared to SKT (107 ml/min/1.73m2 vs. 52 ml/min/1.73m2, p < 0.001). These favourable results persist in the PSM analysis.
Conclusion: EBKTs from very small pediatric donors show excellent long-term kidney function. The higher incidence of postoperative complications does not translate into poorer mid-term patient and graft survival.
期刊介绍：
Frontiers in Pediatrics (Impact Factor 2.33) publishes rigorously peer-reviewed research broadly across the field, from basic to clinical research that meets ongoing challenges in pediatric patient care and child health. Field Chief Editors Arjan Te Pas at Leiden University and Michael L. Moritz at the Children''s Hospital of Pittsburgh are supported by an outstanding Editorial Board of international experts. This multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide.
Frontiers in Pediatrics also features Research Topics, Frontiers special theme-focused issues managed by Guest Associate Editors, addressing important areas in pediatrics. In this fashion, Frontiers serves as an outlet to publish the broadest aspects of pediatrics in both basic and clinical research, including high-quality reviews, case reports, editorials and commentaries related to all aspects of pediatrics.
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