肾移植治疗ITP合并慢性肾衰竭1例报告并文献复习

Renal transplantation for the treatment of idiopathic thrombocytopenic purpura with chronic renal failure:a case report and literature review

目的探讨肾移植治疗特发性血小板减少性紫癜(idiopathic thrombocytopenic purpura,ITP)合并慢性肾衰竭的围手术期处理及移植效果。方法对1例ITP合并慢性肾衰竭患者施行亲属活体肾移植术。术前予以静脉滴注免疫球蛋白及重组人血小板生成素冲击治疗,使其手术当日血小板升至170×109/L,术中未予脾切除,术后常规给予免疫抑制剂、防治感染、支持等治疗。结果受者手术顺利。移植后肾功能恢复正常,随访4年,血小板水平高于术前,凝血指标正常。结论对于ITP合并慢性肾衰竭的患者,行同种异体肾移植手术是安全有效的治疗方法,术中不必行脾切除,适当的术前准备是手术成功的关键。

Objective To explore the perioperative management and transplant effect of renal transplantation for idiopathic thrombocytopenic purpura（ITP） with chronic renal failure.Methods The living-donor renal transplantation was performed in 1 case who was diagnosed as ITP with chronic renal failure.Pulse therapy of immunoglobulin and recombinant human thrombopoietin was given before transplantation.On the operation day,the platelet counts of the patients increased to 170×109/L.Splenectomy wasn＇t performed during the operation.Immunosuppression treatment,prevention of infection and other relevant supports were given after operation.Results The operation was successfully performed and the function of kidney grafts recovered well.During the 4-year follow-up,the level of platelet was higher than that before transplantation and blood coagulation function was normal.Conclusions Allogeneic renal transplantation is a reasonable therapeutic option in patients with ITP combined with chronic renal failure.Splenectomy is not nessesary during the operation.Proper preoperative preparation is the key for successful operation.