6例供者来源性感染致肾移植后血管并发症的诊疗经验  

Management of vascular complications after kidney transplantation caused by donor derived infection:a report of 6 cases

作　　者：张龙[1] 周江桥[1] 邱涛[1] 陈忠宝[1] 邹寄林[1] 马枭雄 金泽亚 徐雨 刘修恒[1] Zhang Long;Zhou Jiangqiao;Qiu Tao;Chen Zhongbao;Zou Jilin;Ma Xiaoxiong;Jin Zeya;Xu Yu;Liu Xiuheng(Department of Organ Transplantation,People's Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院器官移植科,武汉430060

出　　处：《中华器官移植杂志》2022年第6期340-345,共6页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金项目(82170664、81870067)。

摘　　要：目的总结供者来源性感染致移植肾血管并发症的治疗经验, 以提高救治成功率。方法回顾性分析2015年1月1日至2020年12月31日期间武汉大学人民医院收治的供者来源性感染致移植肾血管并发症的6例受者临床资料, 总结分析其年龄、性别、肾移植术式、免疫诱导方案、免疫抑制方案、感染预防措施、并发症发生时间、并发症类型、感染病原菌、诊治方案及预后。结果 2015年1月1日至2020年12月31日期间武汉大学人民医院共进行997例次肾移植, 其中6例受者发生供者来源性感染致移植肾血管并发症, 总发生率为0.6%。3例受者通过分泌物培养及血培养发现耐碳青霉烯类肺炎克雷伯菌(CRKP), 2例受者通过血培养及病理检查发现白色念珠菌, 1例受者通过血培养发现泛耐药金黄色葡萄球菌。6例供者来源性感染导致的血管并发症中的3例为移植肾假性动脉瘤, 通过介入治疗后其中1例保肾成功, 2例短期内感染复发并最终因心脏并发症死亡;2例移植肾动脉破裂出血, 行移植肾切除并恢复血液透析;1例移植肾动脉狭窄, 通过介入治疗行移植肾动脉支架置入, 移植肾功能恢复正常, 随访2年至今移植肾功能稳定。结论介入治疗和开放手术是治疗供者来源性感染致移植肾血管并发症的两种主要方法。介入治疗可增加保肾机会但需注意感染复发风险。开放手术是控制移植肾周感染的有效手段, 可根据受者病情选择保肾或切肾方案。Objective To summarize the institutional experiences of treating vascular complications caused by donor-derived infection(DDI)after kidney transplantation(KT).Methods From January 1,2015 to December 31,2020,clinical data were retrospectively reviewed for 6 cases of vascular complications caused by DDI.Age,gender,surgical approaches,immunity induction therapy,immune suppression therapy,infection prevention,onset time of complication,type of complications,infection pathogens,therapeutic protocols and prognoses were summarized.Results Six patients developed vascular complications caused by DDI in 997 KT recipients with an overall morbidity rate of 0.6%.In 3 cases,carbapenem resistant Klebsiella pneumoniae were positive in culture of secretion and blood samples.And Candida albicans was detected by blood cultures and pathological examinations.One case of antibiotic resistant Staphylococcus aureus was detected by blood culture.Among 3 cases of transplant kidney artery pseudoaneurysm on interventional therapy,there were curing(1 case)and immediate recurrent infection(2 cases).The latter two eventually died by cardiac complications.In 2 cases of arterial hemorrhage,graft nephrectomy was followed by hemodialysis.One case of transplanted renal artery stenosis was successfully cured by artery stenting and survived with normal graft function so far.Conclusions Interventional endovascular therapy and open surgery are indicated for vascular complications caused by DDI post-KT.Interventional therapy may boost the odds of rescuing transplant kidney.However,clinicians should watch out for the risk of recurrent infection.Open surgery is an effective tool of eliminating infected focus.Preserving transplant kidney or nephrectomy may be adopted on the basis of specific conditions.

关 键 词：肾移植 移植后血管并发症 感染 

分 类 号：R699.2[医药卫生—泌尿科学]