Source: Health Times reporter Kong Tianjiao
"When will it be my turn to operate on me?" This is what a patient around ten years old has been asking his doctor. Due to the unfortunate infection with HIV virus, the patient needed long-term antiviral therapy, and was later diagnosed with kidney disease, gradually developed uremia, and could only continue hemodialysis treatment.
After nearly a year of preparations, the transplant team of Guangxi Zhuang Autonomous Region People's Hospital of Guangxi Academy of Medical Sciences performed kidney transplant surgery for children infected with HIV virus and kidney failure, and now the patient's transplanted kidney function has returned to normal. It was also the first case in the country to perform a kidney transplant for an AIDS child.
"The family took the child to many hospitals for treatment, the child's immunity is low, and he has just experienced a serious lung infection, which is very critical." On January 17, Lai Yanhua, director of the transplant department of Guangxi Zhuang Autonomous Region People's Hospital, told the Health Times reporter that after multiple evaluations, kidney transplantation is the best treatment for the child, but kidney transplantation in HIV-infected patients was previously an absolute contraindication, because anti-rejection drugs will make the HIV virus uncontrollable, and now with the development of antiviral suppression drugs, the reception of kidney transplantation by HIV-infected people has become a relative contraindication.
In the process of monitoring and adjusting the treatment plan, the child saw that other hospitalized children had completed surgery and returned to school, and he also began to be anxious. He once asked Lai Yanhua: "When will it be my turn to operate?" "I couldn't give him a clear answer at the time. But the goal has always been clear, not only to do the operation, but also to be smooth and successful. ”
The surgery faces multiple difficulties. Lai Yanhua explained to the Health Times reporter, "AIDS children with uremia have greater difficulty in receiving hemodialysis, and children are not as stable as adults in terms of blood vessels, hemodynamics, blood pressure fluctuations, etc." In addition, HIV will attack human immune cells, if the amount of virus replication is large, the child's immunity will be very low, which may lead to a further increase in the virus, which needs to be prepared in advance. ”
After 8 months of adjustment and preparation, the child's lung infection was cured and stabilized, hiv-RNA turned negative for more than half a year, the level of the immune system reached normal, combined with the consultation of relevant foreign literature and cases, Director Lai Yanhua believes that the child has reached the surgical standard.
Subsequently, the hospital initiated transplant preparations. After more than a month of waiting, the child was successfully matched to the right kidney source, and the team successfully performed kidney transplantation for the child after 3 hours of hard work. Lai Yanhua told reporters: "The whole preparation time, nearly a year, I saw the parents' affection for their children and their trust in doctors, and the children were also very strong, and their desire to survive was particularly strong. On the day of discharge, Lai Yanhua wrote in the circle of friends: "Assessment is difficult, adjustment is difficult, waiting is difficult; surgery is smooth, recovery is smooth, and discharge is smooth!" Bless this little friend. ”
Although the operation was successfully carried out, there are still many problems that need to be paid attention to for the child, Lai Yanhua explained: "The child has only completed the first stage of treatment, passed the dangerous period of surgery and acute rejection, and the long-term risk also includes chronic rejection and infection, because the rejection drugs eaten now will lead to a decline in immunity, so it may lead to opportunistic infection, but also long-term monitoring." ”
Behind the country's first kidney transplantation of AIDS children, Lai Yanhua believes that "on the one hand, the progress of efficient antiretroviral therapy (HAART) and the rapid progress of kidney transplantation technology, there are still some patients with cirrhosis, liver failure, and eventually lead to kidney failure, uremia, hoping that through transplantation, so that AIDS patients have a better quality of life." On the other hand, it is also a progress for children's organ transplantation, with the development of technology, transplant technology is becoming more and more mature, including xenotransplantation, etc., are breaking through. ”