畸形肾血管体外重建在肾移植中的应用:2年随访结果

目的:供肾肾动脉常存在解剖学变异,应用这些血管畸形肾进行移植的临床效果尚无统一意见.观察体外重建畸形供肾血管对肾移植临床效果的影响.方法:选择解放军兰州军区总医院全军泌尿外科中心2006-06/2009-05行尸体供肾伴血管畸形患者27例为实验组,其中17例具有副肾动脉,另10例肾动脉为两三支畸形,均无法直接进行血管吻合.以同期进行正常尸体供肾肾移植患者22例作为对照组.体外血管重建的方法包括动脉端端吻合11例、端侧吻合6例、侧侧共干吻合6例、利用供体或受体髂动脉及其分支合并及延长供肾动脉4例.术后随访观察出血、新出现高血压(或高血压加重)、肾动脉狭窄、移植肾肾功能延迟恢复、急性排斥反应的发生率以及血肌酐水平.结果:移植后平均随访2年,两组患者49例均存活.实验组2例,对照组3例移植后出现高血压或高血压加重,两组间差异无显著性意义(P=0.673),但未发现移植肾动脉狭窄;实验组和对照组移植后肾功能延迟恢复发生率分别为20%和14%,急性排斥反应发生率分别为13%和5%,血肌酐水平分别为(119±11),(127±8) μmol/L,两组间差异均无显著性意义(P=0.179,0.385,0.658).结论:选择适当方法进行供肾畸形血管的重建不影响肾移植效果,可提高供体器官的利用率.

In vitro reconstruction of malformed renal blood vessels prior to kidney transplantation: 2 years follow-up

OBJECTIVE: Anatomic variation of renal artery existed in donor kidney, and whether the variation would affect clinical effects is unconfirmed. This paper is aimed to study the outcomes of in vitro reconstruction of malformed renal blood vessels on outcome of kidney transplantation. METHODS: Patients treated with kidney transplantation at Department of Urology, Lanzhou General Hospital of Chinese PLA were selected; including 27 cases underwent kidney transplantation with malformed blood vessels. Seventeen of them had accessory renal artery, 10 of them with two or three renal arteries. Additional 22 patients transplanted with normal kidney during the same period were selected as the control group. Bench surgery with microsurgical techniques was employed for the repair of the vessels, which included 11 cases of end to end anastomosis of arteries, 6 cases of end to side anastomosis of arteries, 6 cases of side to side conjoined anastomosis of arteries, and 4 cases of renal artery lengthening with an interposition of donor or recipient iliac artery. The hemorrhage, hypertension, renal arterial stenosis, delayed graft function, incidence rate of acute rejection, and the serum creatinine level were followed up.RESULTS: Totally 49 cases were received a mean 2-year follow-up, and no death occurred in both groups. Two cases in the experimental group, and 3 cases in the control group were suffered hypertension or hypertension aggravated, the difference had no significant (P =0.673). No arterial stenosis occurred during the follow up. In the experimental and control groups, the incidence of delayed graft function was 20% and 14%, the incidence of acute rejection was 13% and 5%, and mean serum creatinine at 2 year was (119±11) and (127±8) μmol/L, respectively, the difference was not significant between two groups (P=0.179, 0.385, 0.658).CONCLUSION: Donor kidneys with malformed vascular can be used for transplantation after bench reconstruction, which do not influence the outcome of kidney transplantation.