移植肾动脉狭窄危险因素对比研究

Retrospective study of the risk factors of transplant renal artery stenosis

目的探讨移植肾动脉狭窄(TRAS)发病的危险因素。方法回顾性分析我院2000￣2005年术后经移植肾动脉造影确诊为TRAS的26例肾移植术后病人临床资料。分层随机抽样选择52例目前移植肾存活、血压及移植肾功能均稳定、无血管及尿路并发症的非TRAS病人作为对照,2组病例在手术时间、性别、年龄、基础疾病、血型相配、群体反应性抗体、HLA配型、免疫抑制治疗方案等条件相匹配,比较两组冷缺血时间、急性排斥、移植肾功能延迟恢复和动脉吻合方式等可能事件同TRAS的发生相关性。结果TRAS组中发生急性排斥15例(57.7%);移植肾功能延迟恢复7例(26.9%),两者均高于对照组(P<0.05)。冷缺血时间和动脉吻合方式对TRAS无影响(P>0.05)。结论同种异体肾移植术后移植肾动脉狭窄与急性排斥及移植肾功能延迟恢复有关,而与冷缺血时间及动脉吻合方式无关。

Objective To investigate the risk factors of transplant renal artery stenosis （TRAS）. Methods The clinical records of 26 patients undergoing renal transplantation in our hospital between 2000 and 2005 were retrospectively analyzed, whose final diagnosis of TRAS was established on the basis of arteriographic findings. A case-control group of 52 post-renal transplantation patients were sampled by stratified randomization, whose blood pressure and renal gratt function were without complications of avascularity or urinary passage. The two groups were matched for the operation time, gender, age, primary diseases, blood type, PRA and HLA matching and use of immunosuppressants. Possible events related to TRAS such as cold ischemia time, acute rejection, delayed gratt function and approaches of arterial anastomosis were compared. Results Fifteen patients （57.7%）with TRAS had a history of acute rejection episode, 7 （26.9%） had delayed graft function, both rates of which were higher than those in the control group （P〈0.05）. The cold ischemic time and type of arterial anastomosis showed no significant effect on TRAS occurrence （P〉0.05）. Conclusions Post-transplant renal artery stenosis is closely associated with acute rejection and delayed graft function but not with the cold ischemic time or the type of arterial anastomosis.