供/受体体表面积比值在儿童供肾移植中的作用及应用

摘要

目的 研究供/受体体表面积比值(D/R BSA)在心脏死亡儿童供体单肾移植中的作用,并对其应用进行初步探讨.方法 回顾性研究该中心自2010~2014年开展的13例供体年龄为2~18岁的心脏死亡儿童供体单肾移植.根据D/RBSA比值将患者分成两组:A组D/R BSA<0.8;B组D/R BSA≥0.8.比较不同分组间供受体基本资料、术后早期并发症、术后1年内肾小球滤过率(e-GFR)及移植肾存活情况的差异.结果 两组间供体性别、年龄、体重、身高、体表面积、原发病及术前肌酐等差异无统计学意义(P>0.05).两组受者术后早期并发症的发生率比较差异无统计意义(P>0.05).两组术后1、3、6及12个月的肾小球滤过率的平均值分别为(63.2±5.0)vs(74.0±7.6)(P=0.008);(66.2±4.9)vs(75.8±5.9)(P=0.004);(69.0±4.8)vs(79.0±6.3)(P=0.004);(69.4±7.9)vs(79.2±8.4)(P=0.033).A组术后1年移植肾存活率为62.5%,B组移植肾存活率为94.4%;B组高于A组,差异有统计学意义(P=0.042).结论 当儿童供体的年龄>2岁时,D/R BSA比值>0.8有利于心脏死亡儿童供体单肾移植术后移植肾功能的恢复,并且有助于受者的合理选择.%Objective To evaluate the utility of donor / recipient body surface area (D/R BSA, BSA of donor/ BSA of recipient) by studying the impact of D/R BSA on kidney transplantations from pediatric donors. Methods We retrospectively analyzed 26 cases of kidney transplantations from pediatric donors whose age ranged from 2 to 18 years old, which were performed in our center from 2010 to 2014. Patients were divided into two groups based on D/R BSA: group A<0.8, group B≥0.8. All recipients received a single kidney. Demographics of donors and recipients, early postoperative complications, estimated glomerular filtration rate (e-GFR) and short-term graft survival (≤1 year) were compared between each group to evaluate the impact of D/R BSA on kidney transplantations from pediatric donors. Results All demographics and early postoperative complications of group A were similar to those of group B (P>0.05). E-GFR in group A and group B at one, three, six and twelve months post transplantation were: (63.2 ± 5.0) vs (74.0 ± 7.6), P=0.008;(66.2 ± 4.9) vs (75.8 ± 5.9), P=0.004; (69.0 ± 4.8) vs (79.0 ± 6.3), P=0.004; (69.4 ± 7.9) vs (79.2 ± 8.4), P=0.033. Short-term graft survival of group A was inferior to that of group B (62.5% vs 94.4%, P= 0.042). Conclusions We conclude that recipients with high D/R BSA are more likely to have better graft function when the age of pediatric donor is more than 2 years old. It is possible to make optimal allocation of pediatric donor kidneys on the basis of D/R BSA (≥0.8).