肾移植术后移植肾功能延迟恢复的处理(附14例报告)

Treatment of delayed graft function in renal transplantation(report of 14 cases)

目的探讨肾移植术后移植肾功能延迟恢复(DGF)的原因及处理措施。方法通过对发生DGF的14例患者临床表现、血肌酐、环孢素A(CsA)血浓度、彩色多普勒超声、移植肾细针穿刺吸抽细胞学检查(FNAB)等分析,诊断移植肾静脉栓塞1例,CsA中毒性肾损害2例,急性肾小管坏死(ATN)6例,急性排斥反应(AR)5例。分别予血液透析、手术探查、调整免疫抑制剂种类或剂量等处理。结果1例移植肾静脉栓塞患者行移植肾切除术;13例患者9-27 d尿量增多,术后1个月复查肾功能良好。结论DGF原因包括技术性并发症、CsA中毒性肾损害、ATN、排斥反应等,应结合临床表现及辅助检查,早期诊断,及早采取血液透析、手术探查、调整免疫抑制剂种类或剂量等措施,可取得良好效果。

Objective To investigate the cause and treatment for delayed graft function （DGF） in renal transplantation. Methods Among 14 cases of DGF, one was diagnosed as renal vein embolism, two as nephrotoxicity caused by CsA, six as acute tubular necrosis （ATN） and five as acute rejection （AR）. The diagnoses were confirmed by clinical presentation, blood creatinine, color Doppler ultrasonography, and fine needle asperation biopsy （FNAB）, etc. All cases were individually treated with hemodialysis, surgical exploration and the adjustment of immunosuppressant. Results In 13 cases, urinary output has been increased 9 to 27 days after the operation and renal function recovered one month after operation. One case underwent nephrectomy because of renal venous embolism. Conclusion The cause of DGF included surgical complications, nephrotoxicity caused by CsA, ATN and AR. It should be diagnosed early on clinical presentation and assistant examination, and treated with hemodialysis, surgical exploration and the adjustment of immunosuppressant with satisfactory results.