肾移植术后早期移植肾切除原因分析  

Cause analysis of early allograft nephrectomy after renal transplantation

作　　者：汪逊 王宣传 戎瑞明 许明 纪元 朱同玉 WANG Xun;WANG Xuan-chuan;RONG Rui-ming;XU Ming;JI Yuan;ZHU Tong-yu(Department of Urology,Zhongshan Hospital,Fudan University,Shanghai Key Laboratory of Organ Transplantation,Shanghai 200032,China;Department of Urology,Jinshan Hospital,Fudan University,Shanghai 201508,China)

机构地区：[1]复旦大学附属中山医院泌尿外科,上海市器官移植重点实验室,上海200032 [2]复旦大学附属金山医院泌尿外科,上海201508

出　　处：《中国临床医学》2021年第3期482-484,共3页Chinese Journal of Clinical Medicine

基　　金：国家自然科学基金(81800659)。

摘　　要：目的:探讨肾移植术后早期移植肾切除的原因。方法:选择2008年至2018年复旦大学附属中山医院收治的早期移植肾切除患者20例,收集肾移植术后移植肾切除时间、临床特征、辅助检查结果及术后移植肾病理等数据,分析早期移植肾切除原因。结果:20例患者肾移植术后移植肾切除的中位时间为9.5(0~77)d。彩色多普勒示超声示移植肾内血流均稀疏、阻力指数较高。术后病理显示,20例患者中移植肾血管栓塞10例(50%)、排斥反应5例(25%)、出血后改变2例(10%)、移植肾感染2例(10%)、原发性移植肾无功能1例(5%)。20例患者中,9例为公民逝世后器官捐献(donation after citizen death,DCD)供肾,其中2例因感染切除移植肾,病原菌分别为鲍曼不动杆菌和毛霉菌。结论:早期移植肾切除的主要原因为移植肾血栓形成和急性排斥反应;感染为DCD肾移植患者早期移植肾切除的原因之一。Objective:To explore the causes of early allograft nephrectomy after renal transplantation.Methods:From 2008 to 2018,20 patients with early nephrectomy were selected from Zhongshan Hospital,Fudan University.The data of graft nephrectomy time,clinical features,auxiliary examination results,and postoperative pathology results were collected,and the causes of early graft nephrectomy were analyzed.Results:The median time of allograft nephrectomy after renal transplantation in 20 patients was 9.5(0-77)days.Color Doppler ultrasound results showed that the blood flow was sparse and the resistance index was higher in the allograft renal.Postoperative pathology showed that 10(50%)patients had arterial or venous thrombosis in the allograft renal,5(25%)patients had rejection,2(10%)patients had hemorrhage,2(10%)patients,1(5%)patient had primary non-function of the allograft renal.Among the 20 patients,9 patients received donation after citizen death(DCD)donor kidneys,2 of whom were given allograft nephrectomy due to infection.The pathogens were Acinetobacter baumannii and Mucor.Conclusions:The main cause of early allograft nephrectomy is renal thrombosis and acute rejection,and infection is one of the causes of early nephrectomy for DCD kidney transplantation.

关 键 词：移植肾切除 阻力指数 血栓 排斥反应 感染 

分 类 号：R699.2[医药卫生—泌尿科学]