特发性血小板减少性紫癜患者接受肾移植的安全性观察

目的  探讨特发性血小板减少性紫癜(ITP)患者接受肾移植的安全性。 方法  回顾性分析两例ITP肾移植患者的临床资料并结合相关文献进行复习。 结果  两例患者肾移植术前血小板计数分别为41×10⁹/L及34×10⁹/L, 凝血功能正常, 临床无活动性出血表现, 均成功进行肾移植手术, 术中、术后无明显出血。1例患者术后接受氢化可的松冲击治疗3 d并服用以环孢素为基础免疫抑制剂, 术后7 d血小板计数恢复至正常范围并维持稳定。另1例患者术后接受甲泼尼龙冲击治疗3 d并服用以他克莫司为基础的免疫抑制剂, 术后应用多种提升血小板药物并输注血小板治疗, 血小板波动在10×10⁹/L~30×10⁹/L。两例患者移植肾功能均恢复良好。 结论  ITP患者的肾移植手术出血的风险性主要与患者在术前有否活动性出血有关, 术前无活动性出血的尿毒症患者行肾移植是相对安全的。

Observation on safety of renal transplantation in patients with idiopathic thrombocytopenic purpura

Objective To investigate the safety of renal transplantation in patients with idiopathic thrombocytopenic purpura (ITP). Methods Clinical data of two ITP patients undergoing renal transplantation were retrospectively analyzed and pertinent literatures were reviewed. Results Prior to renal transplantation, the platelet count of these two patients was 41×109/L and 34×109/L, respectively. The coagulation function was normal and no active bleeding was observed. They underwent renal transplantation successfully without obvious bleeding intra-or post-operatively. The platelet count of one patient who received hydrocortisone impulse therapy for three days and maintenance treatment with immunosuppressant based on ciclosporin recovered to normal range and kept stable at 7 days after renal transplantation. Though receiving platelet-promoting drugs and platelet infusion, the platelet count of the other patient treated with methylprednisolone impulse therapy for 3 days and maintenance therapy with immunosuppressant based on tacrolimus did not recover to normal range but fluctuated between 10×109/L and 30×109/L after renal transplantation. Renal function was well maintained in both recipients. Conclusions The risk of renal transplantation related bleeding in ITP patients is correlated with whether the preoperative active bleeding or not. Renal transplantation is relatively safe for uremia patients without active bleeding pre-operation.