尿石症性肾衰患者的肾移植2例报告

报告２例尿石症性肾功能衰竭患者接受肾移植的临床情况，结果２例肾移植获成功；术后随访：１例２年７个月死于肝硬化、腹水及消化道大出血，１例术后５个月失去随访，认为此类患者肾移植成功的关键有３点：（１）认真做好术前检查，寻找病因；（２）术中注意手术方法与技巧的运用；（３）术后加强移植肾Ｂ超及Ｘ线的随访复查。     

高龄尿毒症患者的尸体肾移植

目的 探讨高患者施行肾移植术的特点。方法 对３１例年龄超过５０岁的肾移植患者的资料回顾性分析，其中年龄最大者７２岁，结果 ３１例患者，存活２５例，死亡６例，其中４例于术后近期死亡，２例死于肺部感染，１例死于脑血管意外，１例死于骨髓抑制，另２例分别于术后１８个月，２年死于肝癌和猝死。术后发生超急性排斥１例，急性排斥７例次，肺部感染７例，尿路感染５例。结论 高龄并非肾移 植的绝对禁忌证；高龄患者耐受力     

肾移植术前尿毒症患者合并症的手术治疗体会

目的 总结肾移植术前尿毒症合并症的手术治疗体会。以提高肾移植预后，方法 回顾性分析１９７８年至今尿毒症合并症３９例的手术指征。围手术期治疗以及肾移植预后情况，其中成人性多囊肾９例、药物不可控制性高血压２１例、脾功能亢进４例、胃溃疡５例。结果 ９例多囊肾切除术后１～６个月行肾移植术。随访肾功能正常；２１例高血压患者术后血压不同程度下降，术后６～１２个月行同种肾移植术，肾功能稳定；４例脾脾切除患者肾移     

自体肾移植术的临床应用

目的：探讨自体肾移植术在尿路及非尿路疾病中的应用价值。方法：应用自体肾移植术治疗9例患者，其中肾血管性高血压3例，腹主动脉瘤3例，肾肿瘤2例，输尿管肿瘤1例。结果：术后均未出现并发症，随访6～72个月，平均35个月。其中8例患者肾功能正常，1例肾肿瘤患者于术后13个月因肿瘤复发并颅内转移死亡。结论：自体肾移植术对某些特殊的尿路和非尿路疾病是有效的治疗手段。     

移植肾输尿管短缺肾移植术的尿路重建（附7例报告）

报告７例供肾输尿管短缺情况下肾移植术中尿路重建的方法。其中行供肾与受者输尿端端吻合４例，供肾肾盂与受者输尿管吻合２例，供肾肾盂与受者膀胱吻合１例。除１例供肾肾盂与受者输尿管吻合术后发生漏尿外，均愈合良好。随诊６～２４个月未发现吻合口狭窄。供肾肾盂与受者膀胱吻合１例，术后反复发生泌尿系感染。提示当移植肾发生输尿管短缺时，只要针对具体情况，采取灵活的手术方法，是可以在肾移植术中使尿路重建的。     

直接检测并发丙型肝炎病毒感染的肾移植患者肝组织内丙型肝炎病毒RNA

我们对１例肾移植后９年１０个月并发丙型肝炎的患者直接测定肝组织内丙型肝炎病毒ＲＮＡ，早期明确了诊断，现报告如下。一、临床资料１．病史介绍：患者为男性，４２岁。于１９８５年１２月２９日因高血压性肾病、尿毒症在外院行同种异体肾移植术，术后移植肾功能恢复良...     

活体亲属供肾移植29例报告

目的 总结亲属活体供肾移植的临床经验。方法 回顾总结２９例亲属活体供肾移植的效果及供者损肾后的恢复情况。结果 ２９名供者供肾后未出现严重的并发症,至今全部存活。２７例受者肾功能正常,均恢复日常工作;１例受者术后１４个月因感染并肝功能衰竭死亡;另１例术后１２天因肺内出血栓塞死亡。人／肾１年存活率为９６．６％。结论 亲属活体供肾移植效果明显优于同期尸体供肾移植,但目前我国施行数量太少,尚需大力推广。     

合并顽固性高血压的尿毒症患者肾移植前切除双肾对移植肾功 …

目的 探讨尿毒症合并药物难以控制的高血压患者移植前切除双肾对术后血压及移植肾功能的影响。方法 ４２例合并顽固性高血压的尿毒症患者分成２组（每组２１例），一组先行双肾切除，６个月～１年后再行肾移植，另一组不切肾，直接施行肾移植。对比分析２个组肾移植术后的血压及移植肾功能的恢复情况。结果 切肾组在双肾切除后，１３例（６１．９％）的平均舒张压低于９０ｍｍＨｇ或较术前降低１０ｍｍＨｇ以上；６例（２８．６％     

高龄患者肾移植60例次报告

本文报告我院１９７８年４月至１９９２年１月期间，对５０岁以上的高龄患者作肾移植术６０例次，术后，发生各种并发症达６０％，其中发生术后急性排斥反应占２１．６％。术后人／肾１年存活率为８１．７％／７６．７％。故认为选择高龄患者行肾移植时尤应慎重，有明显的心、肺及脑疾病患者，暂不宜手术。肾动脉吻合方式宜采用肾动脉与骼外动脉端侧连续吻合，其效果较好。对术后发生急性排斥反应的患者，应避免盲目应用大剂量激素，     

单光子发射型计算机断层仪在肾移植监测中的价值

肾移植术后３个月内移植肾急性排斥发生率约为１７％,慢性移植肾失功发生率达 ８．１％～３９％。应用精确、灵敏、早期全面反映肾功能的检测方法,对移植肾急、慢性排斥反应监测,指导临床及时采取措施是非常关键的。我们应用单光子发射型计算机断层仪（简称ＳＰＥＣＴ）对6３例肾移植后患者的肾功能进行了监测,现报告如下。 资料与方法 １．对象的选择与分组方法：选择华西医科大学和济宁医学院附属医院１９９６年 １月～１９９８年 １２月首次行同种异体肾移植患者６３例,对照１３例。均于术后3周做ＳＰＥＣＴ（Ｅｌｓｉｎｔ ＳＰＸ－…     

Clinical analysis on 48 cases of kidney transplantation from brain and cardiac death donors

Objective To observe the short-term clinical outcomes of kidney transplantation from brain and cardiac death donors (DBCD) and assess its feasibility to expand organ donor pool. Methods A retrospective analysis was performed on 48 cases of kidney transplantation from DBCD.The transplant recipients had finished 12-month follow-up in the First People's Hospital of Foshan from September 2011 to February 2015, with their renal function, rejection reaction and complications at 1 week, 1 month, 3 months, 6 months and 12 months after renal transplantation being collected. Survival rates of transplant recipients and transplant kidneys, incidence of delayed graft function (DGF) and its influence for recipients and graft survival were analyzed by statistics. Results In the 48 cases, the survival rates of recipients at 1, 3, 6 and 12 months after transplantation were 100.0%, 100.0%, 97.9%, 95.8%, and the survival rates of transplanted kidneys were 95.8%, 95.8%, 93.8%, 91.7%, respectively. DGF occurred in 8 of 48 (17.0%), but the occurrence of DGF did not adversely influence patient's survival (P=0.524) or graft survival (P=0.362). Conclusions The short-term clinical outcomes of kidney transplantation from DBCD are ideal. As the legislation of donation after brain death (DBD) has not been ratified in China, the kidney transplantation from DBCD could be an important way to solve the shortage of organs, and increase the number of kidneys available for transplantation.     

心脏死亡供者供肾移植14例报告

目的 总结心脏死亡供者供肾的获取以及应用于临床肾移植的经验.方法 共7例心脏死亡供者捐献了供肾,进行了14例肾移植.7例供者年龄30～53岁,原发病为脑出血3例,颅脑外伤2例,脑基底动脉闭塞1例,颅脑肿瘤卒中1例;威斯康辛大学评分为19～23分,均为高危组.7例供者的所有近亲家属签署器官捐献知情同意的相关文件.临床评估供肾良好,供者心脏停跳2～5min后确定为心脏死亡,并采用腹腔多器官联合快速切取技术获取双侧肾脏.14例受者与供者HLA抗原错配数为2～4个,受者淋巴细胞毒交叉配合试验≤0.05,群体反应性抗体＜10％.7例供者中有6例的热缺血时间为5～10 min,1例为45 min;冷缺血时间为4.5～12.5 h.结果 利用心脏死亡供者供肾的14例肾移植手术均顺利完成.14例受者中,术后发生原发性移植肾无功能(PNF)1例,移植肾功能恢复延迟(DGF)3例,急性排斥反应2例;其中1例因PNF在术后第1天切除了移植肾,并恢复规律血液透析,1例因DGF仍在恢复中(尚处于术后3个月),血清肌酐149μmol/L,该2例受者均接受了热缺血时间为45 min的供肾;其余12例受者痊愈出院,移植肾功能均良好.结论 遵照《中国心脏死亡器官捐献指南》开展心脏死亡器官捐献工作,维护好潜在供者的各项重要生命指标,可以保证供肾质量;心脏死亡供者供肾可作为肾移植的重要器官来源,并且移植效果良好.     

扩大标准公民逝世后器官捐献肾移植术后一年内临床效果分析

目的观察并比较扩大标准供者(ECD)和标准供者(SCD)供肾移植受者术后1年内临床效果。 方法回顾性分析2014年3月至2017年3月空军军医大学西京医院接受公民逝世后器官捐献90例肾移植受者临床资料,按供肾来源分为ECD组(31例)和SCD组(59例)。所有受者均应用免疫诱导及三联免疫抑制方案治疗(吗替麦考酚酯或麦考酚钠肠溶片＋他克莫司或环孢素＋甲泼尼龙)。采用t检验或Mann-Whitney U检验比较两组受者肾移植术后1年内血清肌酐(Scr)水平,采用χ²检验和Fisher确切概率法比较两组受者性别比例、受者/移植肾存活率及急性排斥反应(AR)、移植肾功能延迟恢复(DGF)和肺部感染等并发症发生率。P<0.05为差异有统计学意义。 结果ECD组和SCD组肾移植受者术后Scr水平逐步下降。术后1个月内(术后1、3、7、14和21 d)两组受者Scr水平差异均无统计学意义(t＝0.076、0.905、0.670、0.893和0.048,P均>0.05);术后1～12个月,除术后9个月两组受者Scr水平差异无统计学意义(t＝1.727,P>0.05),其余各时间点ECD组受者Scr水平均高于SCD组,差异均有统计学意义(P均<0.05)。两组受者术后1年受者/移植肾存活率分别为93.1%/80.6%和91.5/84.7%,差异均无统计学意义(P＝0.734; χ²＝0.246,P>0.05)。ECD组和SCD组AR发生率分别为12.9%(4/31)和18.6%(11/59),DGF发生率分别为22.6%(7/31)和22.0%(13/59),肺部感染发生率分别为25.8%(8/31)和11.9%(7/59),其他并发症发生率分别为41.9%(13/31)和28.8%(17/59),差异均无统计学意义(P均>0.05)。 结论与SCD相比,ECD供肾移植仍可获得相当的临床效果。在目前供器官来源严重缺乏的情况下,ECD的合理选择可以扩大供肾来源。     

多囊肾患者肾移植的临床研究

目的 探讨多囊肾患者肾移植的特点、不切除原双侧肾脏的可行性及其对移植效果的影响。方法 总结了２８例多囊肾患者肾移植的临床研究结果。最大年龄６２岁,平均５６．２岁;透析时间３～１８个月。移植术前、术中及术后均未节除原双侧肾脏。移植后观察肾脏体积及血尿的变化,采取积极的防治感染措施。结果 １年人肾存活率均为９５．２％,３年存活率８５．７％,最长存活已９年;急性排斥反应的发生率１０．７％,移植后原肾脏体     

One-year routine renal transplant biopsies in children

In our institution, systematic renal graft biopsies are performed 1 year after transplantation before deciding to switch to alternate-day steroid therapy, which has been shown to be beneficial for statural growth. We analyzed the results of systematic graft biopsies in 145 children with a creatinine clearance > or =45 ml/min per 1.73 m2. Biopsies were classified according to Banff diagnostic categories. Normal parenchyma was observed in 19 cases (13%), non-specific lesions in 42 cases (29%), chronic allograft nephropathy grade 1-3 in 68 cases (49%), and acute rejection in 8 cases (5%). Clinicopathological correlations indicated that patients with chronic allograft nephropathy had received kidneys from older donors, with longer cold ischemia time and with a higher incidence of delayed graft function. There was a strong correlation between the donor age and the presence of vascular lesions. There was also a good correlation between the severity of histological lesions and the occurrence of acute rejection episodes during the 1st year after transplantation. Renal function remained stable for up to 10 years in patients with normal parenchyma or non-specific lesions, while serum creatinine levels increased after the 2nd year in patients with chronic allograft nephropathy.     

多囊肾与肾移植相关关系的研究

目的 研究多囊肾尿毒症患者肾移植术前是否需要切除多囊肾。方法 对30例多囊肾尿毒症患者肾移植后进行随访，比较生存率及生活质量。结果 切除多囊肾后肾移植的3、5年生存率分别为100％、70％，肾移植后患者可恢复正常工作。未切除多囊肾的肾移植3、5年生存率为70％、50％，肾移植后生活质量没有提高。结论 多囊肾尿毒症患者，肾移植前应常规切除多囊肾，以提高移植后3、5年生存率和生活质量。     

肾移植术后并发双侧自体肾盂和输尿管移行细胞癌16例

目的 总结肾移植术后发生双侧自体肾盂、输尿管移行细胞癌的诊治经验.方法 回顾性分析16例肾移植术后发生双侧自体肾盂、输尿管移行细胞癌患者的资料.首次发现上尿路肿瘤的时间为移植后(56.2±33.0)个月.2例同时发现双侧上尿路肿瘤,其余14例双侧上尿路肿瘤先后发现的时间间隔为(8.6±6.7)个月.临床症状和检查阳性结果以血尿和自体肾积水为主.均行自体上尿路根治性切除术,术后行膀胱灌注化疗.结果 16例手术均成功.32次自体肾、输尿管的病理检查结果均为移行细胞癌,包括单纯肾盂肿瘤4次,单纯输尿管肿瘤9次,合并肾盂、输尿管肿瘤19次.23次肾盂肿瘤的分级为1级8例,2级11例,3级4例;28次输尿管肿瘤的分级为1级6例,2级10例,3级12例.术后随访(26.8±25.1)个月,1例出现肺部转移后死亡;1例发生腰背部软组织转移性移行细胞癌,局部切除;其他患者未发现肿瘤复发及转移.结论 肾移植后自体上尿路移行细胞癌的常见表现为血尿合并自体肾积水,该肿瘤侵袭性较强,对于膀胱及一侧自体上尿路同时存在移行细胞癌者,应行对侧自体肾上尿路预防性切除术.

Abstract：

Objective To investigate the clinical features of bilateral native pelvic and ureteral transitional cell carcinoma (TCC) in renal transplant patients. Methods A retrospective analysis was carried out on 16 patients with bilateral native pelvic and ureteral TCC after kidney transplantation.The mean time between transplantation and diagnosis of upper urinary TCC was 56. 2 ± 33. 0 months.Two patients were suffered from bilateral upper urinary TCC at the same time. The mean interval between 2 upper urinary tract operations of the remaining 14 cases was 8. 6 ± 6. 7 months. Hematuria and hydronephrosis of native kidneys were the main symptoms and targets in checkup. Intravesical chemotherapy was postoperatively given. Results All operations were performed successfully. All specimens obtained from the operations were pathologically diagnosed as TCC. The TCC location involved pure native pelvis (n = 4), pure native ureter (n = 9), and pelvis combined with ureter (n = 19). Pelvic TCC pathological grades included grade 1 in 8 cases, grade 2 in 11 cases, and grade 3 in 4 cases; Ureteral TCC grades included grade 1 in 6 cases, grade 2 in 10 cases, and grade 3 in 12 cases.Patients were followed up for 26. 8 ± 25. 1 months. One patient died of lung metastasis. (One case of lumbar soft tissue transfer was given local excision. The remaining patients had no recurrence and metastasis. Conclusion Renal transplant patients with hematuria and native renal hydronephrosis should be highly vigilant of the occurrence of upper urinary tract TCC. TCC after renal transplantation is invasive. Prophylactic contralateral nephroureterectomy should be performed on the recipients having TCC at the bladder and one side of native upper urinary tract.     

Successful transplantation of kidneys bearing previously mismatched HLA A and B locus antigens

Transplantation of kidneys bearing HLA antigens to which recipients have previously been exposed is generally avoided, and such prudence is a well-documented means of preventing early graft loss. Prior exposure and subsequent reactions can, however, take a wide variety of forms, and blanket avoidance may prevent many deserving patients from being transplanted. In our region, operating through a single tissue-typing laboratory, we follow a consistent policy of allowing retransplantation with kidneys bearing previous mismatches, provided no relevant antibody response has been detected. Twenty-one of 34 such transplants remain functioning at time periods ranging from 7 months to 7 years. Four were lost due to rejection within the 1st month, and the remaining 9 functioned for periods ranging from 2 months to 8 years. Three were lost for reasons other than rejection. Our antibody screening policy and our criteria for a negative crossmatch results in the exclusion of two-thirds of all repeat mismatch transplantations. The results indicate that in the remaining third, transplantation can be performed across a repeat mismatch with excellent long-term results, provided our defined crossmatch policy is adhered to strictly.     

移植肾尿路结石的腔内治疗

目的探讨腔内治疗移植。肾尿路结石的效果和策略。方法采用腔内技术治疗13例移植。肾尿路结石，其中。肾结石3例，金属支架结石1例，输尿管结石9例，合并输尿管口狭窄2例。结石最大直径8～48mm，接受肾移植的时间1个月～8年。结果3例。肾结石和1例金属支架结石行经皮微造瘘输尿管镜取石术成功取石。4例输尿管结石行逆行输尿管镜取石治疗；3例行经皮顺行输尿管镜取石成功，其中1例合并移植输尿管口狭窄者同时行内切开取石；1例移植输尿管口狭窄合并下端结石者，改行开放手术；1例输尿管结石直接行体外冲击波碎石术2次后排净结石。术后随访1～8年，人肾存活均良好，12例患者。肾功能恢复正常，无结石复发。结论移植肾尿路结石处理应选择创伤小、效果好的腔内微创治疗，尽可能保护。肾功能。     

Successful transplantation of kidneys bearing previously mismatched HLA A and B locus antigens

Abstract. Transplantation of kidneys bearing HLA antigens to which recipients have previously been exposed is generally avoided, and such prudence is a well-documented means of preventing early graft loss. Prior exposure and subsequent reactions can, however, take a wide variety of forms, and blanket avoidance may prevent many deserving patients from being transplanted. In our region, operating through a single tissue-typing laboratory, we follow a consistent policy of allowing retransplantation with kidneys bearing previous mismatches, provided no relevant antibody response has been detected. Twenty-one of 34 such transplants remain functioning at time periods ranging from 7 months to 7 years. Four were lost due to rejection within the 1st month, and the remaining 9 functioned for periods ranging from 2 months to 8 years. Three were lost for reasons other than rejection. Our antibody screening policy and our criteria for a negative crossmatch results in the exclusion of two-thirds of all repeat mismatch transplantations. The results indicate that in the remaining third, transplantation can be performed across a repeat mismatch with excellent long-term results, provided our defined crossmatch policy is adhered to strictly.