早期急性排斥反应导致移植肾动脉狭窄的诊治分析

Diagnosis and management of transplant renal artery stenosis caused by early stage acute allograft rejection

目的探讨肾移植术后早期由急性排斥导致移植肾动脉狭窄的治疗方法及疗效。方法回顾经彩色多普勒超声筛查并经动脉造影证实为移植肾动脉狭窄并同时经移植肾穿刺病理证实发生急性排斥反应的3例肾移植患者的治疗过程。结果3例患者造影证实移植肾动脉狭窄未予球囊扩张或支架治疗，给予抗排斥治疗，3例患者治疗均取得成功，患者血压和肌酐均较前明显下降，随访B超无狭窄表现。结论彩色多普勒超声可用于移植肾动脉狭窄的筛查和治疗后随访，移植肾动脉造影是其诊断的金标准，急性排斥是引起移植肾动脉狭窄的原因之一，明确动脉狭窄原因为急性排斥后抗排斥治疗是有效的治疗方法。

Objective To investigate the diagnosis and management of transplant renal artery stenosis （TRAS） caused by early stage acute allograft rejection. Method A retrospective study was conducted in 3 cases with diagnoses of TRAS and early stage acute allograft rejection confirmed by color Doppler ultrasonography, renal artery angiography, and renal graft biopsy. Results Antirejection therapy was carried on subsequently rather than percutaneous transluminal angioplasty or percutaneous transluminal angioplasty and stenting. The blood pressure and creatinine level which were abnormal at the time of diagnosis of TRAS and acute allograft rejection returned to normal after antirejection treatment in those patients. Moreover, TRAS was not detected any more by color Doppler uhrasonography during the follow-up period. Conclusion TRAS is associated with early stage acute allograft rejection episodes. Color Doppler ultrasonography is useful in screening and follow-up of TRAS. Transplant renal arteriography is the gold standard for diagnosis. Antirejection therapy is an effective therapeutic modality other than percutaneous transluminal angioplasty or angioplasty and stenting for TRAS.