肾移植术后肺毛霉菌感染2例并文献复习

毛霉菌广泛存在于自然界中,对正常人通常无致病力,为一种机会性感染真菌.Paltauf等[1]于1885年首次报道了人类感染毛霉菌,毛霉菌病具有侵袭力强、进展快、致死率高的特点,目前在人群中发病率每年约1.2 /100万人[2].根据累及的器官不同,毛霉菌病可分为鼻脑型、肺型、胃肠型、播散型、皮肤型以及其他混合类型.肺毛...     

肾离体手术在肾移植中的临床应用二例并文献复习

目的总结肾离体手术在肾移植中的临床应用经验。方法 2002年2月至4月第四军医大学西京医院泌尿外科分别行离体肾肿瘤剜除术后自体肾移植1例和离体供肾输尿管镜下钬激光碎石清石术后亲属活体肾移植1例。分析2例受者临床资料并进行文献复习。结果病例1：离体手术中肿瘤完整剜除,病理检查切缘未见癌组织,自体肾移植手术顺利;随访7个月,血清肌酐、血尿素氮水平略高于正常,无需透析,无肿瘤复发及转移。病例2：输尿管镜下可见离体供肾内两枚直径分别为8和12mm的结石,均成功取出;肾移植术中留置输尿管支架;术后未见相关并发症,随访10个月,移植肾内未见结石复发。结论肾离体手术有助于减少手术损伤,最大限度地维护患者肾脏功能,减少等待肾移植人群。正确选择适应证至关重要。     

肾移植术后移植肾癌肉瘤1例报告并文献复习

目的：提高对肾移植术后移植肾癌肉瘤的认识及诊疗水平。方法：回顾性分析1例肾移植术后移植肾癌肉瘤患者的临床资料：患者女,73岁,因尿毒症于1996年10月在外院行肾移植术,移植肾置入右髂窝;因移植肾失功能于2001年3月行第二次肾移植术．移植肾置于左侧髂窝。2006年11月出现右侧移植肾区疼痛,伴镜下血尿。B超、CT检查发现右侧移植肾占位性病变而入院。在全麻下行移植。肾探查术．将右侧移植肾完整切除。结果：手术顺利,手术时间3h．出血量150ml,病理检查报告为移植肾癌肉瘤。术后2个月,患者出现排斥反应与肠梗阻,病情急剧恶化,家属放弃治疗。结论：移植肾癌肉瘤恶性程度高,预后极差．早期诊断有助于提高生存率。     

ABO血型不相容肾移植5例临床报告并文献复习

目的:探讨ABO血型不相容肾移植临床效果并进行相关文献复习。方法:回顾性分析2017年5月～2018年12月在我院施行的5例ABO血型不相容肾移植供受者的临床资料。基于受者初始血型抗体效价水平,采用利妥昔单抗、血浆置换和免疫抑制剂相结合的个体化脱敏治疗方案。结果:经个体化脱敏治疗,5例受者在肾移植手术当天血型抗体IgM、IgG效价水平均≤1∶8,其中4例于术后2周内未出现血型抗体效价反弹,患者肾功能顺利恢复至正常,同时在围手术期未出现明显凝血功能障碍;随访至今患者移植肾功能稳定。1例于术后第3天血型抗体效价出现反弹,考虑发生血型抗体导致的急性抗体介导排斥反应,临床综合治疗后效果差,于术后第9天行二次肾移植手术(公民逝世后器官捐献供肾,血型相容),随访至今移植肾功能稳定。结论:根据血型抗体效价水平采用利妥昔单抗、血浆置换和免疫抑制剂相结合的个体化脱敏治疗进行ABO血型不相容肾移植是安全、可行的。     

肾移植术后妊娠4例次报告并文献复习

目的 探讨肾移植术后妊娠对肾移植患者及胎儿的影响以及妊娠后免疫抑制药物的合理应用.方法 回顾分析4例次肾移植术后妊娠的临床资料并复习相关文献.结果 3例女性患者均接受同种异体肾移植术,术后妊娠4例次,1次因移植肾失功人工引产,二次肾移植后再次妊娠.移植术后至妊娠前2例患者应用环孢素(CsA)+麦考酚吗乙酯(MMF)+泼...     

肾移植围手术期的血液净化治疗

肾移植患者存在许多与血液净化相关的问题,本文比较详细地阐述了血液净化对移植肾与患者的影响,肾移植围手术期进行血液净化的适应证、治疗机制以及注意事项.     

肺癌肺移植一例临床分析并文献复习

目的结合1例肺癌肺移植受者临床资料及国内外研究现状,探讨肺癌肺移植临床应用价值。方法回顾性分析浙江大学医学院附属第一医院胸外科2013年12月26日完成的1例肺癌肺移植受者临床资料。男性,66岁,原发病为双肺纤维化。在全身麻醉下行体外膜肺氧合辅助右侧单肺移植术。结合文献,对肺癌肺移植的适应证、术前评估、术式选择、术后治疗方案及预后等方面展开讨论,总结肺癌肺移植的临床应用价值。结果手术过程顺利,术中切除右侧病肺,其冰冻切片病理学检查示多发病灶腺癌,术后病理检查示多灶性肺泡上皮异型增生癌变。术后采用吗替麦考酚酯+类固醇激素免疫抑制方案,予呼吸机辅助通气,先后并发胸腔包裹性积血积液、气道内出血伴肺部严重感染,于术后7 d自动出院。结论肺移植在治疗非转移性肺部恶性肿瘤方面具有潜在的应用价值,需要严格选择适应证、明确病理分期并完善治疗方案,其远期预后有待进一步研究。     

肾移植术后原肾恶性肿瘤2例报告并文献复习

目的 探讨肾移植术后原肾恶性肿瘤的临床特点,提高该疾病的临床诊治水平.方法 回顾分析经治的2例肾移植术后原肾恶性肿瘤患者的发病情况、肿瘤特点、治疗方案、随访结果和预后,复习国内外文献,针对该2病例特点进行分析总结.结果 2例患者均在规律随访时经B超发现原肾恶性肿瘤,分别为肾移植后39个月和112个月.病例1行根治性肾切除术,术后病理为透明细胞癌,术后免疫抑制剂改为包含雷帕霉素的治疗方案,至今随访8年,肿瘤无复发,移植肾功能正常.病例2发现原肾恶性肿瘤后拒绝手术治疗,6个月后肿瘤转移,失去切除肿瘤机会,采用舒尼替尼治疗4个月,因难以耐受不良反应而停药,目前门诊随访,发现肿瘤后存活18个月,移植肾功能正常.结论 肾移植术后原肾恶性肿瘤例数不多,但发生率明显高于正常人群,肾移植术后随访中应加强针对性筛查,及早发现原肾恶性肿瘤.原肾恶性肿瘤发生后如果能及时行根治性切除术,预后较好,如有转移可以采用靶向药物进行治疗.原肾恶性肿瘤术后采用包含雷帕霉素及其类似物的免疫抑制治疗方案是比较合理的选择.     

Pulmonary Rhizopus infection in a diabetic renal transplant recipient

Infectious complications after renal transplantation remain a major cause of morbidity and mortality. Mucormycosis is a rare infection in renal transplant recipients; however, mortality is exceedingly high. Risk factors predisposing to this disease include prolonged neutropenia, diabetes, and patients who are immunosuppressed (Singh N, Gayowski T, Singh J, Yu LV. Invasive gastrointestinal zygomycosis in a liver transplant recipient: case report and review of zygomycosis in solid-organ transplant recipients, Clin Infect Dis 1995: 20: 617). Life-threatening infections can occur, as this fungus has the propensity to invade blood vessel endothelium, resulting in hematological dissemination. We report a case of cavitary Rhizopus lung infection, 2 months after renal transplantation, where the patient was treated successfully with Amphotericin B and surgical resection of the lesions with preservation of his allograft function. In this era of intensified immunosuppression, we may see an increased incidence of mucormycosis in transplant population. Invasive diagnostic work-up is mandatory in case of suspicion; Amphotericin B and, in selected cases, surgical resection are the mainstays of therapy.     

移植肾动脉血管并发症29例报道并文献复习

目的总结移植肾动脉血管并发症的临床特点与治疗经验。方法 2007年6月至2014年6月解放军281医院收治的322例肾移植患者中,29例肾移植患者术后出现移植肾动脉血管并发症。对29例移植肾血管并发症患者的临床资料进行回顾性分析,总结该病的临床特点及治疗经验。结果移植肾动脉吻合口出血2例,移植肾内动脉痉挛23例,移植肾动脉血栓形成2例,移植肾动脉狭窄2例。移植肾动脉吻合口出血患者为术后动脉吻合口出血,予及时手术探查止血。移植肾内动脉痉挛患者,术中给予抗痉挛处理后移植肾由暗红、质地软转为饱满红润。移植肾动血栓形成患者,确诊后立即进行手术探查,移植肾呈暗红色,恢复血供后仍未恢复正常,予以切除。移植肾动脉狭窄,采用球囊扩张及支架置入术,患者血压恢复正常,肾功能正常。结论移植肾动脉血管并发症进展迅速,病情变化快且后果严重,为降低其发生率,提高治愈率,积极预防和果断处理十分重要。     

Acutely exaggerated hepatitis B induced by the withdrawal of immunosuppressants in a seroconverted renal transplant recipient: report of a case

The long-term reciprocal impact of renal transplantation on infection by hepatitis B virus (HBV) is still a matter of intense debate, and the topic remains controversial. We herein report the case of a 50-year-old male asymptomatic HBV carrier who had seroconverted to positive anti-HBe antibody (Ab) and received a kidney transplantation from a cadaver donor (HB surface(s) antigen (Ag)-negative). Nine months later, his kidney function deteriorated due to chronic rejection, and hemodialysis was temporarily required. Triple drug therapy (cyclosporine, prednisolone, azathioprine) for immunosuppression was changed to two-drug therapy (cyclosporine and prednisolone) at a reduced dosage because of this episode. After that episode, severe hepatitis with HBV antigenemia developed without any change in the serological state. The levels of DNA polymerase in a potential recipient from a cadaveric donor should be checked before transplantation to predict the occurrence of hepatitis when the recipient is an asymptomatic carrier of HBV, especially in cases of serologically HBeAg-negative, and anti-HBeAb-positive carriers. Received: April 3, 2000 / Accepted: November 20, 2001     

Double endocrine neoplasia in a renal transplant recipient: case report and review of the literature

Introduction

The incidence of cancer compared for age groups is 3-4 times higher in transplant recipients than the general population. The increased risk is related to immunosuppressive therapy as well as the use of increasingly older donors and recipients. Although cardiovascular disease with a functioning transplant is the leading cause of death (47%), cancer mortality is significant especially among older patients. However, the most frequent posttransplantation cancers relate to hemolymphopoietic organs and skin, whereas the occurrence of solid tumors elsewhere is rare. Herein we have described a rare case of synchronous double malignancy of endocrine organs (thyroid-adrenal) in a young woman who underwent renal transplantation.

Case Report

A 37-year-old woman with end-stage renal disease for 18 years underwent transplantation when she was 30 years old with a 17-year-old standard cadaveric donor receiving immunosuppressive therapy with mycophenolate mofetil, cyclosporine, and steroids. Follow-up demonstrated good indices of renal function with negative tumor pathology at 79 months when, at an annual ultrasound monitoring, we found a lesion in the right lobe of the thyroid and left adrenal neoplasm of dubious interpretation. The cytology for the thyroid was highly suspicious of papillary carcinoma, whereas the histological examination after surgery diagnosed a thyroid multifocal papillary microcarcinoma (mpT1NxMx) and an oxyphil cell adrenocortical carcinoma (pT2, N0).

Results

Six months after total thyroidectomy with central lymphadenectomy and left kidney and adrenal gland removal the patient showed no evidence of recurrent lesions and stable graft function.

Conclusions

The rare occurrence of solid tumors after transplantation has no known etiopathogenetic relation. Despite the young age of the patient and the double neoplasm that could have produced an unfavorable outcome for the patient and the graft, careful follow-up for tumor pathologies and multidisciplinary management achieved an early diagnosis of both tumors with a surgical eradication without adjuvant therapy, preserving the life of the patient and the function of the graft.     

肾移植术后新发宫颈癌1例报道并文献复习

目的探讨肾移植术后新发宫颈癌的诊治和筛查方法。方法 2009年11月3日,中山大学附属第一医院妇产科收治1例55岁肾移植术后4年的新发宫颈鳞癌患者,外院宫颈环形电刀锥切术病理结果示"宫颈中、低分化鳞状细胞浸润癌",B型超声(B超)示宫颈大小22mm×26mm×34mm,宫颈后壁肌层内见12mm×7mm大小的低回声区。诊断为肾移植术后新发宫颈鳞状细胞癌(国际妇产科联盟临床分期Ⅱa期)。予腹腔镜下行广泛子宫切除+盆腔淋巴结清扫术,术后补充拓扑替康单药化学药物治疗(化疗)4个疗程,第1个疗程0.75mg/m2静脉滴注,每日1次,连用4d,间隔21d,共行4个疗程,并于第2～4个疗程调整拓扑替康剂量为1.25mg/m2。术后调整免疫抑制治疗方案,停用泼尼松,环孢素改用原剂量的1/4,继续应用麦考酚吗乙酯,并嘱定期规则随访。结果患者手术顺利,对单药拓扑替康辅助化疗耐受良好,除出现Ⅲ度骨髓抑制外,未发生排斥反应及其它并发症。出院后定期随访,随访至投稿日患者已健康存活32个月,复查肾功能正常、鳞状细胞癌抗原(squamous cell carcinoma antigen,SCCA)正常,生殖道高危型人乳头瘤病毒(-),阴道细胞学涂片正常,未见肿瘤复发表现。结论肾移植术后新发宫颈癌的早期治疗以根治性手术为主,肾移植术后接受规范筛查有助于早期发现宫颈癌。     

Unusual Merkel cell carcinoma in a renal transplant recipient: case report and review of the literature

Merkel cell carcinoma (MCC) is an uncommon and aggressive neuroendocrine primary skin cancer known for its high propensity for local recurrence and distant metastases. There is no consensus regarding the optimal therapeutic approach, and the relative roles of surgery, radiotherapy and chemotherapy are still controversial. MCC generally affects elderly patients in areas of actinically damaged skin. Several studies suggest that a more aggressive course is observed in immunocompromised patients such as organ transplant recipients. Clinically, MCC usually appears as a rapidly growing, dome-shaped and solitary nodule. More than half of these tumours occur in the head and neck, and can become a challenge for the plastic and reconstructive surgeon. An unusual case of this cutaneous malignancy is presented in a renal transplant recipient. The tumour was located in the medial canthus of the eye. Tumour resection was performed and a reverse flow pre-auricular island flap and a forehead flap were used for reconstruction.