KC Tse, MC Chiu, WM Lai, Sc Lau

Abstract

Successful renal transplantation is the best renal replacement therapy for children with end stage renal disease. In the present study, we reviewed our experience with renal transplanted children currently managed in our Department. There were 20 transplants done in 19 Chinese children from 4/1992 to 2/2002. The most common cause of renal failure was renal dysplasia (27%) followed by focal segmental glomerulosclerosis (FSGS) (16%). Seven allografts came from living donors and 13 were from cadaveric donors. Three children underwent pre-emptive transplantation. The mean waiting time for local cadaveric kidney was 4.4 ± 2.3 years. Mean age at transplantation was 15.3 ± 4.5 years and the mean duration of follow-up was 2.4 ± 2.4 years. Immunosuppressive protocol consisted mainly of triple therapy with prednisolone, azathioprine/mycophenolate mofeteil, and neoral/FK506. Lamivudine was used in 5 children with chronic HBV infection with no flare-up of the infection at the last follow-up and with good tolerance of the drug. There was no case of CMV infection. Acute rejection occurred in 5 allografts (25%); and chronic rejection occurred in 4 allografts (20%). There were 3 graft loss (15%) due to resistant acute rejection, chronic rejection and recurrence of the original renal disease respectively. Actuarial graft survival rate at 1 year and 3 years post-transplantation were 100 % for living donor kidney and those for cadaveric donor kidney at 1 year and 3 years were 92.3% and 83.1% respectively. The mean GFR was 71.8 ± 17.2 ml/min/1.73 m². Actuarial patient survival rate was 100%. Most of them were able to go back to school or be employed. In conclusion, good short-term graft survival rate and excellent patient survival rate had been achieved with kidney transplantation in children in our Center. Chronic allograft nephropathy and recurrence of the original renal disease remained the major problems to long-term graft survival. Lamivudine might make transplantation feasible in those chronic HBV infected ESRD patients.

成功的腎移植是兒童終末期腎病最有效的治療方法。我們回顧了正在接受我科追蹤複查的腎移植後的病例。自 1992年 4 月至 2002 年 2 月期間，我科共為 19 名中國兒童進行了 20 例的腎移植。最常見的腎衰竭病因為腎發育異常(27%)，其次為侷灶性節段性腎小球硬化( FSGS)(16%)，7 例為同種活體供腎，13 例為屍體供腎。3 名兒童在移植術前不進行透析治療而直接進行腎移植。平均等候本地屍體供腎時間為 4.4 ± 2.3 年。平均受者年齡為 15.3 ± 4.5 歲，平均複查期為 2.4 ± 2.4 年。免疫抑制方案主要包括三聯療法：強的松龍，硫唑嘌呤/麥考酚鹽，和環孢霉素/FK506。Lamivudine 被應用於乙型肝炎病毒感染而隨診期間無急性發作的 5 個病例中，全部都耐受此藥物。回顧所有的病例，無巨細胞病毒感染病例。 5 例同種供腎病例發生了急性排斥反應(25 %)，4 例同種供腎病例發生了慢性排斥反應(20 %)。有 3 例移植失敗(15%)是分別由於急性排斥反應，慢性排斥反應和原發疾病的復發。精算活體移植腎 1 年和 3 年的存活率為 100%，而屍體供腎的移植 1 年和 3 年的存活率分別為 92.3% 和 83.1%。平均腎小球濾過率為71.8 ± 17.2 ml/min/1.73m²。精算病人存活率為 100%。大多數患者均能重返學校和工作崗位。綜上所述，我們中心在兒童腎移植方面已經取得了良好的短期移植腎存活率以及極好的患者存活率。然而，慢性移植腎腎病和原發腎病復發仍為移植腎長期存活所面對的主要問題。 Lamivudine 的應用也許可以增加受乙型肝炎病毒感染的終末期腎病患者進行腎移植的可行性。