儿童供肾给儿童肾移植术后肾动脉狭窄5例  

Renal artery stenosis in children after pediatric donor kidney transplantation: a report of five cases

作　　者：郭志良 萨如拉 赵光远 张瑜 曾和松[3] 朱兰[1] 陈刚[1] Guo Zhiliang;Sa Rula;Zhao Guangyuan;Zhang Yu;Zeng Hesong;Zhu Lan;Chen Gang(Institute of Organ Transplantation,Affiliated Tongji Hospital,Tongji Medical College,Huazhong University of Science&Technology,Key Laboratory of Organ Transplantation,Ministry of Education,National Health Commission's Key Laboratory of Organ Transplantation,Key Laboratory of Organ Transplantation,Chinese Academy of Medical Sciences,Wuhan 430030,China;Department of Pediatrics,Affiliated Tongji Hospital,Tongji Medical College,Huazhong University of Science&Technology,Wuhan 430030,China;Department of Cardiology,Affiliated Tongji Hospital,Tongji Medical College,Huazhong University of Science&Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院器官移植研究所器官移植教育部重点实验室国家卫生健康委员会器官移植重点实验室中国医学科学院器官移植重点实验室,武汉430030 [2]华中科技大学同济医学院附属同济医院儿科,武汉430030 [3]华中科技大学同济医学院附属同济医院心内科,武汉430030

出　　处：《中华器官移植杂志》2022年第1期4-8,共5页Chinese Journal of Organ Transplantation

基　　金：同济医院临床研究领航项目(2019CR108)。

摘　　要：目的分析儿童供肾给儿童肾移植术后移植肾动脉狭窄的临床特点,探讨其发生发展的可能影响因素。方法回顾性总结华中科技大学同济医学院附属同济医院2014年5月1日至2021年6月30日期间89例儿童供肾给儿童肾移植受者随访过程中发生移植肾动脉狭窄的临床资料,中位随访29个月内共发生移植肾动脉狭窄5例(5.6%)。5例儿童供者、受者的中位年龄分别为9个月和11岁,2例为双供肾移植,3例为单供肾移植,肾动脉均采用端侧吻合。诊断移植肾动脉狭窄的中位时间为术后10个月(3~60个月),除1例3岁受者发生时间较早外,余4例均发生在儿童受者肾移植后的快速生长期,身高最大增幅为30 cm。5例中3例有移植部位的再次手术史,包括同侧再次肾移植手术1例和移植肾尿路重建术2例。5例儿童受者均表现为高血压、2例伴血肌酐升高。4例彩色多普勒超声检测移植肾动脉流速>300 cm/s,5例CT血管造影或磁共振血管造影均示移植肾动脉狭窄,程度50%~95%。结果4例行球囊扩张后2例显著缓解,1例复发后经支架置入好转,1例效果不明显而最终移植肾功能丧失。1例观察6个月后狭窄自行部分缓解而暂未做特殊处理。结论儿童供肾给儿童肾移植术后的移植肾动脉狭窄是一个并不少见的严重并发症,供肾过小和受者的快速生长可能是潜在的危险因素,影像学确诊后首选球囊扩张,慎用经皮血管内支架成形。Objective To explore the clinical features of transplanted renal artery stenosis after pediatric donor kidneys in children.Methods We retrospectively summarized the clinical data in five cases of transplanted renal artery stenosis undergoing deceased pediatric donor kidney transplantation from May 1,2014 to June 30,2021.Donor/receptor characteristics,diagnosis,treatment and prognosis were recorded.The median follow-up period was 29 months.The median age of five donors and recipients was 9 and 132 months respectively.En bloc renal allograft(n=2)and single kidney transplantation(n=3)were performed.End-to-side anastomosis was performed for renal arteries.The median diagnostic time of renal artery stenosis was 10(3-60)months post-transplantation.Except for one 3-year-old recipient with an earlier onset of stenosis,four stenotic cases during a rapid growth period had a maximal height increase of 30 cm post-transplantation.Three of them had a history of surgery at graft site,including previous kidney transplantation(n=1)and transplant urinary tract reconstruction(n=2).All five cases had hypertension and two showed an elevated serum level of creatinine.Ultrasound indicated a significantly elevated flow rate of>300 cm/s(n=4)and CTA/MRA indicated that the degrees of stenosis varied from 50%to 95%(n=5).Results After balloon dilatation,stenosis either improved(n=2)or relapsed(n=2).Further stenting succeed(n=1)or failed(n=1).One case of stenosis was relieved partially after 6-month observation without any invasive treatment.Conclusions As a serious complication,transplant renal artery stenosis is common after pediatric donor kidney transplantation.Too small size in donor kidney and rapid recipient growth may be specific risk factors.After diagnosis,balloon dilation is a preferred treatment.Stent placement should be cautiously employed.

关 键 词：肾移植 移植肾动脉狭窄 经皮腔内血管成形 

分 类 号：R726.9[医药卫生—儿科]