「腎臟移植」治療青春期少年末期腎病的最佳方式

【記者 玉女 台中 報導】

兒童罹患慢性腎臟病主因與成人大不同,根據「台灣少年慢性腎臟病主因及現況趨勢」報告指出,兒童罹患慢性腎臟病的主因有高達51.9%是先天性腎臟及泌尿道異常、48.1%為腎絲球腎炎、1.7%為先天性代謝異常症或遺傳疾病。據統計,全國大約有20萬名慢性腎臟病童,進展到末期腎臟病患者的盛行率為百萬分之五左右。雖然聽起來遙不可及,但小兒腎病透析盛行率卻逐年成長,從2010年開始五年之間接受透析治療的兒童從451人增加到527人。一旦接受長期的透析治療,對兒童的健康、發育、心理及生活品質等都會造成非常大的負擔。

對於末期腎病的兒童,更好的治療選項為腎臟移植手術。在許多文獻中都證實,與透析治療相比,接受腎臟移植的病童有較好的長期存活率、及較佳的生活品質。更好的是,小於六歲的病童接受腎臟移植後對未來的生長比接受透析治療好。目前腎臟移植的來源有成年近親提供的活腎移植、和腦死器官捐贈的屍腎移植。活腎移植有較佳的腎存活率和不用接受透析而進行腎移植,整體十年存活率大約 70 – 80%。屍腎移植的腎存活率雖然較差,仍然有60-70%。較大的問題是腎臟的供應不足,平均需等待4-5年。

泌尿科陳順郎主任及謝佐宜醫師表示去年有一位因車禍導致顱內出血的腦死病患,由他院轉送至中山醫學大學附設醫院,將腎臟分別捐贈給兩位青春期少年。這兩位病童分別為17及13歲,他們末期腎病的原因分別是罕見的亞柏氏症候群、及局灶節段性腎小球硬化症。他們已接受長期的腹膜透析,並在本院治療追蹤。器官摘除手術進行後,當天也緊接著為兩位病童進行腎臟移植手術。手術進行順利,目前術後復原情況良好。記者會當天,將分享兒童腎臟移植的經驗。

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