移植肾动脉狭窄的治疗

移植动脉狭窄处理不当或不及时可导致移植物的丧失，我院于１９９５年１１月－１９９７年１月对４例移植肾动脉狭窄患者，１例行粘连松解术，３例行网状支架植入术，术后血压及肾功能均恢复正常，无并发症，远期效果佳。认为这两种方法是治疗移植肾动狭窄的有效方法。     

移植肾血栓形成3例报告

目的：总结移植肾血栓形成的病因、临床表现、诊断、治疗及预后。方法：回顾分析移植肾动脉血栓形成２例，静脉血栓形成１例的临床资料。结果：１例行移植肾切除术；１例肾动脉取栓术后因未能挽救移植肾功能而最终切除；１例移植肾切除后，即刻在同侧行第２次肾移植术，并取得成功。结论：外科技术失误为其最主要的原因，另外还与高龄、幼儿、女性供体，动脉粥样硬化或狭窄，缺血时间过长等有关。动脉血栓形成主要表现为突发的无尿，     

儿童供肾给儿童肾移植术后肾动脉狭窄5例

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...     

用Strecker网状支架治疗移植肾动脉狭窄一例

我院于１９９５年１１月对１例移植肾动脉狭窄的患者行球囊血管成形术后,再行网状支架植入术,术后血压即降至正常,移植肾功能良好,无并发症,报告如下。一、资料与方法１．一般资料：本例患者为男性,２７岁。于１９９５年８月行同种异体肾移植术（左髂窝内）,患者的...     

成人移植婴幼儿供肾术后移植肾动脉狭窄

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。     

移植肾动脉血流峰值速度加快与移植肾动脉狭窄相关性研究

目的:探讨肾移植术后半年内移植肾动脉血流峰值速度加快与移植肾动脉狭窄相关性。方法:回顾性分析我院102例肾移植患者术后半年内移植肾多普勒超声图像检查结果及临床资料,比较患者收缩期血流峰值速度(PSV)、血压及移植肾功能。结果:102例患者中,有27例患者出现较高的PSV,其中4例患者呈现持续性PSV升高,经行移植肾动脉造影检查而确诊为移植肾动脉狭窄(TRAS),行经皮肾动脉支架植入术(PTRAS)后,PSV降至正常,血压恢复正常,随访6~13个月未见狭窄复发。结论:在肾移植术后半年内,移植肾动脉PSV加快未必是肾动脉狭窄,可先随访观察,若超声提示PSV呈持续性升高,尤其是伴顽固性高血压,则需行移植肾动脉造影明确是否是TRAS。PTRAS是TRAS安全有效的治疗方法。     

供肾动脉带主动脉袖口预防移植肾动脉狭窄

目的:探讨供肾动脉带主动脉袖口预防移植肾动脉狭窄的效果。方法:对955例(1030例次)行肾移植患者的肾移植供肾动脉,全部采用主动脉袖口与受者髂内动脉吻合。应用彩色多普勒血流B超及移植肾动脉血管造影排除移植肾动脉狭窄。结果:955例(1030例次)肾移植无一例出现移植肾动脉狭窄。结论:供肾动脉带腹主动脉袖口可以防止移植后肾动脉狭窄发生。     

自体肾移植治疗肾动脉狭窄伴恶性高血压一例

自体肾移植治疗肾动脉狭窄伴恶性高血压一例姜宁，李延云，王忠，吕嘉福，吴志美我院于１９９２年１月１７日为１例左肾动脉狭窄伴恶性高血压患者施行自体肾移植术，经术后２６个月随访观察，获较好效果。现报告如下。患者，女，３４岁。以头晕、头痛、高血压２年，间歇性...     

移植肾动脉狭窄

移植肾动脉狭窄的发生率在1％～23％左右，是影响移植肾长期存活的重要因素之一。本文综述了移植肾动脉狭窄的原因、诊断和处理方法。     

动脉内支架植入术在移植肾动脉狭窄治疗中的应用

移植肾动脉狭窄(TRAS)是肾移植术后常见的外科并发症之一，动脉内支架植入术(PTRAS)可以有效地对移植肾动脉狭窄进行治疗。我院采用PTRAS先后对14例移植肾动脉狭窄患者进行治疗，疗效颇佳。有关资料报道如下：     

Anastomotic line renal artery stenosis after transplantation

We report on 5 patients with renal artery stenosis after renal transplantation. Renal arteriography showed the stenosis to be localized at the line of arterial anastomosis. The patients presented with refractory hypertension, with or without renal failure, 10 days to 13 months after transplantation. Percutaneous transluminal balloon angioplasty in 4 patients failed in 3 and produced temporary improvement in 1. Resection of the stenosis resulted in dramatic improvement of the clinical state in all 5 patients. Histological examination of the resected stenotic segment revealed a nodular fibrotic lesion at the anastomotic line in all cases, and was associated with extensive calcification in 3. Anastomotic line stenosis should be recognized as a specific entity causing transplant renal artery stenosis. The pathological changes observed explain the failure of transluminal angioplasty and suggest that surgical repair is the treatment of choice. Possible factors in the etiology of anastomotic line stenosis are discussed.     

Arterial stenosis complicating renal allotransplantation in man: a study of 38 cases.

Of 306 renal transplantations, stenosis of the artery supplying the grafted kidney was found in 38 patients three months to two years after they had undergone renal transplantation. The diagnosis was made by arteriography done because of refractory hypertension with or without impaired renal function in 36 patients and as a routine investigation in two normotensive patients. The stenosis was corrected surgically in 14 patients, with resultant lasting relief of hypertension in ten patients and improvement of renal function in five out of six patients with impaired renal function. Different types of stenosis were recognized: stenosis of the recipient artery, stenosis of the suture line, stenosis of the donor renal artery (segmental or diffuse) and multiple forms. The most frequent site of stenosis was the donor artery. There seems to be no single cause of stenosis: atheroma of the recipient vessels, faulty suture technique, hemodynamic disturbances, trauma to donor or recipient arteries account for some cases, whereas in other cases the evidence points to an immune mechanism. This complication of renal transplantation may be more frequent than is thought at present; therefore, routine renal arteriography should be performed at repeated intervals in all transplanted patients.     

Post-transplant renal artery stenosis: a cause of anuria. Report of 2 cases corrected by revascularization

We report 2 cases of severe hypertension and acute onset of anuria after renal transplantation in which angiography revealed renal artery stenosis. After renal artery reconstructive surgery renal function returned to normal and the hypertension improved. A high index of suspicion is needed to make the diagnosis. Only by heightened awareness of this important entity will patients with post-transplantation anuria secondary to renal artery stenosis be identified. Such patients may benefit from renal artery revascularization to reverse this type of renal failure.     

Donors with renal artery stenosis: fit to donate

Kidney donation from hypertensive donors is now an accepted norm in live related kidney transplantation. The use of hypertensive donors with renal artery stenosis due to atherosclerosis and fibromuscular dysplasia is still debated. The prime concern is about the deleterious effect of hypertension on the donor and the risk of recurrence of such lesions in the solitary kidney. Even as the response of atherosclerotic renal artery stenosis to revascularisation is unpredictable, there is an improvement in blood pressure following revascularisation of kidneys with fibro-muscular dysplasia. The first use of such kidney donors was reported in 1984 and, since then, there have been a few reports of successful use of kidneys from donors with renal artery stenosis. We report here two interesting cases of successful transplantation of kidneys from live related kidney donors with hypertension due to renal artery stenosis who became normotensive with good graft function in the recipient. We conclude that moderately hypertensive donors with renal artery stenosis are fit to donate.     

腹部器官移植术后并发症的磁共振检查

目的探讨磁共振在腹部器官移植并发症中的诊断价值。方法对4例肝移植、5例胰肾联合移植及2例肾移植患者进行磁共振检查，检查时间在术后28d至2年，采用GE1．5TMR机型，成像技术包括常规平扫及增强扫描。结果4例肝移植，1例发生肝动脉狭窄伴肝坏死，1例发生下腔静脉血栓形成，1例为肝静脉与下腔静脉吻合口明显狭窄，1例为左右肝管明显狭窄；5例胰、肾联合移植中，1例并发急性排斥反应，1例为移植胰慢性排斥反应伴纤维化，1例为迟发性胰腺炎，移植肾4例正常，1例并发急性排斥反应伴肾梗死；2例单纯肾移植者，1例为肾动脉局限性中度狭窄，1例为肾动脉与髂内动脉吻合口处动脉瘤形成。上述病理改变均经组织病理检查和数字减影血管造影证实。结论磁共振可作为腹部器官移植并发症的一种无损伤检查手段，对于血管并发症，有其独有的优势。     

移植肾破裂肾包膜切开止血法

移植肾自发性破裂是同种异体肾移植术后早期的一个严重并发症，采用肾包膜多处切开结合止血绫－粘涂胶止血法保肾，并行双滤过法血浆分离术（ＤＦＰＰ）和应用抗胸腺细胞球蛋白（ＡＴＧ）治疗６例严重移植肾破裂患者，止血效果达到１００％，４例肾脏得以保存，２例切除移植肾。认为肾包膜多处切开结合止血绫－粘涂胶止血术是治疗严重移植肾破裂的一个安全、可靠和简便的止血保肾法     

Vascular Complications in Renal Transplantation: A Single-Center Experience in 1367 Renal Transplantations and Review of the Literature

Renal transplantation is the treatment of choice for end-stage renal disease. Vascular complications in renal transplantation are not uncommon and may often lead to allograft loss. The most common vascular complications are transplant renal artery stenosis, transplant renal artery thrombosis, transplant renal vein thrombosis, biopsy-induced vascular injuries, pseudoaneurysm formation, and hematomas. Transplant renal artery and vein thrombosis have an early onset and a dramatic clinical manifestation and usually lead to allograft loss. In contrast, transplant renal artery stenosis has better treatment possibilities, whereas the rest do not occur so often. In our institution, 1367 renal transplantations were performed from September 1980 to April 2005. During this period, we encountered 38 major vascular complications leading to graft loss and 19 transplant renal artery stenoses with successful treatment in the majority of cases. According to these data, we can conclude that renal transplantation is a safe therapeutic procedure for renal failure.     

Arterial stenosis in transplanted kidneys. 86 surgically treated cases

Eighty-six patients who had undergone renal transplantation three months to five years before, were operated on for a stenosis of the artery supplying the grafted kidney. The diagnosis was made by angiography performed because of refractory hypertension with or without impaired renal function. Surgical repair of the stenosis cured or improved arterial hypertension in 48 patients and improved renal function in 17 of 29 with impaired renal function. Different types of stenosis were recognized: stenosis of the recipient artery, stenosis of the suture line, stenosis of the donor renal artery (segmental or diffuse) and multiple stenoses. The most frequent site of stenosis was the donor artery. There seems to be no single cause of stenosis: atheroma of the recipient vessels, trauma to donor or recipient arteries, faulty suture techniques, hemodynamic disturbances account for some cases whereas in other cases the evidence points to an immune mechanism. This complication of renal transplantation appears now as the most frequent one; therefore, routine vascular investigations should be performed at repeated intervals in all transplanted patients. Surgical repair is indicated in tight stenoses with impending thrombosis and in stenoses responsible for severe hypertension which does not respond to anti-hypertensive treatment. The other patients with mild to moderate hypertension responding to medical treatment, without renal function impairment, and with moderate stenosis can be managed medically. In our experience, surgical correction of the stenosis is indicated approximately in one half of the patients in whom a stenosis has been discovered.(ABSTRACT TRUNCATED AT 250 WORDS)