成人移植婴幼儿供肾术后移植肾动脉狭窄  

Artery stenosis in renal grafts from infantile donors to adult recipients

作　　者：陈靖 董祥军[2] 夏秋翔 彭景涛 曾宪鹏 李汉英 郭琛 杨华[4] 李恒[1] 王振迪 Chen Jing;Dong Xiangjun;Xia Qiuxiang;Peng Jingtao;Zeng Xianpeng;Li Hanying;Guo Chen;Yang Hua;Li Heng;Wang Zhendi(Department of Urology,Affiliated Union Hospital,Tongji Medical School,Huazhong University of Science&Technology,Wuhan 430022,China;Department of Radiology,Affiliated Union Hospital,Tongji Medical School,Huazhong University of Science&Technology,Hubei Key Laboratory of Molecular Imaging,Wuhan 430022,China;Department of Kidney Transplantation,Affiliated Hospital,Qingdao University,Qingdao,266003,China;Department of Organ Transplantation,Affiliated Jiangxi Provincial People's Hospital,Nanchang University,Nanchang 330006,China)

机构地区：[1]华中科技大学同济医学院附属协和医院泌尿外科,武汉430022 [2]华中科技大学同济医学院附属协和医院放射科湖北省分子成像重点实验室,武汉430022 [3]青岛大学附属医院肾脏移植科,青岛266003 [4]南昌大学附属人民医院器官移植科,南昌330006

出　　处：《中华器官移植杂志》2022年第1期25-29,共5页Chinese Journal of Organ Transplantation

基　　金：国家器官移植发展基金"菁英计划"培育项目(2019JYJH09);湖北省自然科学基金(2020CFB768);国家自然科学基金(81803013)。

摘　　要：目的探讨成人受者接受小儿供肾移植术后发生的移植肾动脉狭窄临床特点、病因、诊断及治疗。方法回顾性分析2014年7月至2019年3月在华中科技大学同济医学院附属协和医院泌尿外科进行的25例小儿供者整块双肾移植和27例小儿供者单肾移植的临床资料(受者均≥18岁)。结果其中1例双肾移植成人受者(4.0%)和2例单肾移植受者(7.4%)在移植术后13~23个月诊断为移植肾动脉狭窄,高于同期接受成人供肾的成人受者移植肾动脉狭窄率(1.1%)。移植肾动脉狭窄成人受者与非狭窄组比较,其供者年龄更小(P<0.05),但是供者、受者体重差异均无统计学意义(P>0.05)。狭窄部位内径1.40~1.63 mm,均为移植肾动脉自供者腹主动脉起始部而非吻合口本身。肾动脉非狭窄段内径2.31~4.93 mm,与相应年龄小儿正常肾动脉一致。3例移植肾动脉狭窄受者行经皮腔内血管成形及支架置入术后均得到有效治疗。结论移植肾动脉狭窄的原因可能与过度剥离肾动脉周围组织,影响其术后继续发育相关。谨慎选择成人受者接受婴儿单供肾,保留肾动脉周围组织可能有助于预防移植肾动脉狭窄。Objective To explore the clinical characteristics,causes,diagnosis and treatment of transplant renal artery stenosis after pediatric-to-adult kidney transplantation.Methods Between July 2014 and March 2019,clinical data were retrospectively reviewed for 25 en-bloc and 27 single kidney transplant cases.Results One en-bloc(4.0%)and two single kidney recipients(7.4%)were diagnosed as renal artery stenosis at Month 13-23 months post-transplantation.It was higher than the rate of stenosis in adult-to-adult transplant cases(1.1%)during the same period.As compared with recipients without stenosis,stenotic ones had younger pediatric donors(P<0.05)and yet similar body weight of donors as well as recipients(P>0.05).The inner diameters of stenonotic sites were(1.40-1.63)mm and predominant stenotic site was proximal renal artery rather than anastomotic site.The remaining parts of major renal arteries varied from 2.31 to 4.93 mm in diameter.It was normal in children with a corresponding age.All three cases responded well to percutaneous transluminal angioplasty and stenting.Conclusions The cause of stenosis may be an undeveloped local artery diameter due to extensive tissue dissection around artery.Therefore cautious selections of infantile single renal graft for adult recipients and preserving surrounding tissue of renal artery assist in the prevention of graft arterial stenosis.

关 键 词：肾移植 移植肾动脉狭窄 整块双肾移植 

分 类 号：R699.2[医药卫生—泌尿科学]