目的 探讨我国肾移植分配政策的改变对维持性血液透析儿童患者血管通路选择的影响。方法 收集2013年1月—2022年12月进行血液透析并建立长期血管通路患儿的临床资料，包括年龄、体重、体质指数（BMI）、原发疾病、首次血液透析时血管通路的类型等，统计分析2018年我国出台“儿童优先”肾移植新政策前后，儿童血管通路的种类及数量，总结其变化趋势及影响因素。结果 共纳入118例患儿，男66例、女52例，平均年龄（11.4±2.9）岁，中位体重31.1（23.9~43.3）kg。导致儿童发生终末期肾脏病（ESRD）的主要病因为先天性肾脏和尿路畸形（CAKUT）和原发性肾脏疾病。首次透析时96.6%的儿童其血管通路为临时性中心静脉导管（CVC），余3.4%的儿童其血管通路为动静脉内瘘（AVF）。“儿童优先”肾移植新政策实施以后，维持性血液透析患儿的肾移植中位等待时间由19.5个月缩短至8个月。选择AVF作为儿童长期血管通路的比例由86.7%降至43.1%；反之，选择带隧道和涤纶套的透析导管（TCC）作为儿童长期血管通路的比例由13.3%增长至56.9%。结论 “儿童优先”肾移植分配政策实施后，对于ESRD维持性血液透析的患儿来说，TCC取代AVF，成为其血管通路的首选。

Objective To investigate the influence of the change of renal transplantation allocation policy in China on the selection of vascular access in children with maintenance hemodialysis. Methods The clinical data of children who underwent hemodialysis and established long-term vascular access from January 2013 to December 2022 were collected, including age, weight, body mass index, primary disease, type of vascular access at the first hemodialysis, etc. The types and numbers of vascular access in children before and after the introduction of the new policy of "child priority" renal transplantation in China in 2018 were statistically analyzed, and the change trend and influencing factors were summarized. Results A total of 118 children (66 boys and 52 girls) were included. The mean age was (11.4±2.9) years, and the median body weight was 31.1 (23.9-43.3) kg. The main causes of end stage renal disease (ESRD) in children were congenital anomalies of the kidneys and urinary tracts (CAKUT) and primary renal diseases. At the first dialysis, 96.6% of the children had temporary central venous catheter (CVC), and the remaining 3.4% had arteriovenous fistula (AVF). After the implementation of the new policy of "child priority" renal transplantation, the median waiting time for kidney transplantation in children with maintenance hemodialysis was shortened from 19.5 months to 8 months. The proportion of children choosing AVF as long-term vascular access decreased from 86.7% to 43.1%; conversely, the proportion of children choosing tunnel-cuffed catheter (TCC) as long-term vascular access increased from 13.3% to 56.9%. Conclusions After the implementation of the "child priority" kidney transplant allocation policy, TCC replaced AVF as the preferred vascular access for children with ESRD on maintenance hemodialysis.