儿童肾移植后移植肾动脉狭窄7例诊疗分析  

Diagnosis and treatment of transplanted renal artery stenosis in 7 children from deceased donors

作　　者：高鹏飞[1] 李军[1] 伍文睿 吴成林[1] 张强 张桓熙[1] 傅茜[1] 刘龙山[1] 黄勇慧[2] 李淑娟[3] 王长希[1] Gao Pengfei;Li Jun;Wu Wenrui;Wu Chenglin;Zhang Qiang;Zhang Huanxi;Fu Qian;Liu Longshan;Huang Yonghui;Li Shujuan;Wang Changxi(Organ Transplant Center,First Affiliated Hospital,Sun Yat-sen University,Guangzhou 510080,China;Department of Interventional Radiology,First Affiliated Hospital,Sun Yat-sen University,Guangzhou 510080,China;Department of Cardiovascular Pediatrics,First Affiliated Hospital,Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院器官移植中心,广州510080 [2]中山大学附属第一医院放射介入科,广州510080 [3]中山大学附属第一医院心血管儿科,广州510080

出　　处：《中华器官移植杂志》2022年第1期9-13,共5页Chinese Journal of Organ Transplantation

基　　金：广东省科技计划项目(2015B020226002、2017A020215012);广州市科技计划项目(201903010058、201803040011);广东省器官捐献与移植免疫重点实验室基金(2013A061401007、2017B030314018、2020B1212060026);广东省器官移植国际科技合作基地基金(2015B050501002)。

摘　　要：目的探讨儿童肾移植后移植肾动脉狭窄(TRAS)的诊断与治疗。方法收集中山大学附属第一医院2016年1月至2021年8月收治的7例儿童肾移植后TRAS的临床资料。7例儿童受者中男性4例,女性3例。7例儿童受者彩色多普勒超声发现TRAS的中位时间是肾移植后61 d(3~1517 d)。7例TRAS均位于吻合口附近的肾动脉主干处,经计算机断层血管造影(computed tomography angiography,CTA)明确诊断。结果7例TRAS儿童受者的年龄明显高于供者年龄,差异有统计学意义[(11.9±3.7)岁和(1.0±0.5)岁,P<0.001]。5例儿童受者经介入治疗后,移植肾动脉狭窄处管径增宽[(1.98±0.47)mm和(4.64±1.19)mm,P=0.002],狭窄段动脉收缩期峰值流速降低[(463.3±90.6)cm/s和(183.6±58.9)cm/s,P<0.001],收缩压降低[(137.2±15.5)mmHg和(129.7±12.3)mmHg,P=0.029],阻力指数升高(0.38±0.22和0.60±0.03,P=0.063)。估测肾小球滤过率(eGFR)在介入后4周与介入前有明显差异。2例儿童受者介入治疗后发生肾周血肿、支架附壁血栓等并发症。2例儿童受者保守治疗,血压逐步升高,降压药物由1种增至3种。结论儿童肾移植术后应规律行彩色多普勒超声检查,有助于早期发现TRAS。严重TRAS应首选介入手术,以改善血流灌注和肾功能,但需注意并发症。Objective To explore the diagnosis and treatment of transplanted renal artery stenosis(TRAS)in children.Methods From January 2016 to August 2021,clinical data of 7 TRAS patients were collected.A definite diagnosis was confirmed by Doppler ultrasound and computed tomography angiography.Results Patient age was significantly higher than donor age(11.9±3.7 vs 1.0±0.5 years,P<0.001);5 patients had a widened diameter at stenotic grafted renal artery after intervention(1.98±0.47 vs 4.64±1.19 mm,P=0.002).A reduction in peak systolic flow velocity in stenotic segment of artery(463.3±90.6 vs 183.6±58.9 cm/s,P<0.001)and lower systolic blood pressure(137.2±15.5 vs 129.7±12.3 mmHg,P=0.029)were observed.Resistance index rose(0.38±0.22 vs 0.60±0.03,P=0.063).Significant difference of estimated glomerular filtration rate was observed at Week 4 post-operation as compared with pre-intervention.Two patients developed complications after intervention,including perirenal hematoma and stent-attached thrombus.Two patients were treated conservatively with a gradual increase in blood pressure and three antihypertensive drugs prescribed.Conclusions Doppler ultrasound should be performed regularly after renal transplantation for detecting TRAS at an early stage in children.Interventional treatment is ideal for severe TRAS to improve perfusion and renal function.Clinicians should pay more attention to complications.

关 键 词：肾移植 肾动脉狭窄 经皮腔内血管成形 

分 类 号：R726.9[医药卫生—儿科]