肾移植后感染性移植肾动脉破裂五例临床分析  

Clinical analysis of 5 cases of infectious renal artery rupture after renal transplantation

作　　者：许名杰 谢续标[1] 彭龙开[1] 彭风华[1] 蓝恭斌[1] 余少杰[1] 王彧[1] 唐笑天[1] 方春华[1] 聂曼华[1] Xu Mingjie Xie Xubiao Peng Longkai Peng Fenghua Lan Gongbin Yu Shaojie Wang Yu Tang Xiaotian Fang Chunhua Nie Manhua(Fang Chunhua, Nie Manhua. Department of Urological Transplantation, Second Xiangya Hospital of Central South University, Changsha 410011, China)

机构地区：[1]中南大学湘雅二医院泌外器官移植科,长沙410011

出　　处：《中华器官移植杂志》2017年第4期211-217,共7页Chinese Journal of Organ Transplantation

摘　　要：目的 探讨肾移植术后感染性移植肾动脉破裂的防治策略.方法 结合文献对5例肾移植术后感染性移植肾动脉破裂供、受者的临床资料进行分析.结果 5例受者其对应的供者均有导致移植肾动脉感染的潜在因素,5例供者均有供者来源性感染（donor-transmitted infections,DTI）的风险因素,包括肺部感染（1例重症肺炎）、供肾挫裂伤（1例供肾多处挫裂伤）、肠破裂（1例外伤导致小肠破裂）及切取供肾时剪破肠管（2例供肾切取时剪破肠管）.供肾保存液培养发现的致病微生物有肺炎克雷伯菌1例,白色念珠菌1例,粪肠球菌1例,有1例未培养出致病菌,外院切取的供肾保存液未作培养1例.切除的移植肾病理检查均显示动脉管壁坏死、淋巴细胞浸润.术后将切除的移植肾血管壁、周围髂窝组织送细菌、真菌培养发现：1例新型隐球菌（例1）、2例白色念珠菌（例2、例4）、1例肺炎克雷伯菌（例5）,还有1例（例3）未培养出致病菌,但考虑真菌感染可能性大.例1于移植肾动脉再植10个月后行再次移植,随访至今移植肾功能正常;例4于移植肾切除2个月后行再次移植,因难治性排斥反应导致移植肾迅速功能丧失,继续血液透析治疗.其余3例受者均存活至今,等待再次移植.5例受者均未再次破裂出血.结论 移植肾动脉破裂是肾移植术后较严重的并发症之一.严格供、受者的感染学筛查,围手术期应用广覆盖敏感抗菌药物是预防感染性移植肾动脉破裂的关键,早期发现并尽快手术是挽救受者生命唯一治疗措施.Objective To explore the prevention and treatment strategies for the infectious renal artery rupture after renal transplantation of organ donation after citizens death （DCD）.Methods The clinical data of 5 donors and their corresponding recipients with infectious renal artery rupture after renal transplantation were retrospectively analyzed with review of the literature.Results The corresponding donors of 5 recipients had the potential risk factors for donor-transmitted infection （DTI）：1 case of traumatic rupture of small intestine,2 cases of digestive tract injury when resecting the donor kidney from DCD donors,1 case of severe pneumonia and 1 case of multiple renal contusion.The pathogenic microorganisms were found in the culture of kidney preservation solution,including klebsiella pneumoniae in 1 case,candida albicans in i case,enterococcus.No pathogens were detected in 1 case,and kidney preservation solution taken from the external hospital was not cultured in 1 case.The pathological examination on the resected renal grafts revealed the necrosis of the arteries and the infiltration of lymphocytes.The culture of bacteria and fungi in the removed vessel walls of renal grafts and the iliac tissues showed there were 2 cases positive for candida albicans （case 2 and case 4）,1 case for cryptococcus neoformans （case 1）,1 case for klebsiella pneumonia （case 5）.No pathogenic bacteria were detected in 1 case,but the possibility of fungal infection was more likely.In case 1,the second kidney transplantation was performed 10 months later after artery re-transplantation,and the kidney function was normal during the follow-up period.In case 4,the second kidney transplantation was performed 2 months later after transplant nephrectomy due to the refractory rejection,the transplanted kidney experienced a rapid loss of graft function,and the blood dialysis was given continuously.The remaining 3 patients survived so far,waiting for re-transplantation.No case of bleeding occurred again in the 5 recipients.Co

关 键 词：肾移植 公民逝世后器官捐献 肾动脉破裂 感染 供者 

分 类 号：R699.2[医药卫生—泌尿科学]