移植肾作为供肾再次行肾移植一例报告并文献复习

Reuse of a previously transplanted kidney： a case report and the literature review

目的探讨移植肾作为供肾再次用于临床肾移植的效果，并结合相关文献总结经验。方法回顾分析2015年2月利用1例肾移植受者脑死亡后捐献的移植肾作为供肾，为1例尿毒症患者成功施行了同种肾移植术的临床资料。供者为男性，31岁，于2014年11月因尿毒症接受了肾移植，术后肾功能恢复正常。术后2个月因突发神经系统病变导致脑死亡而捐献移植肾。捐献器官前供者血肌酐为167μmol／L，肾小球滤过率约为35ml／min。受者为男性，27岁，因慢性肾功能不全尿毒症期接受肾移植，术前检测群体反应性抗体（PRA）阴性，血肌酐1353μmol／L。经细致完整地分离和修整供肾后，采用Lifeport器官灌注保存运输器对供肾进行灌注及修复。供肾热缺血时间约为15min。术中将供肾静脉与受者右侧髂外静脉端侧吻合，供肾动脉与受者右侧髂内动脉端端吻合，将供肾输尿管与受者右侧输尿管离心端吻合。结果移植手术耗时3h余，受者术后采用他克莫司＋吗替麦考酚酯＋甲泼尼龙的三联免疫抑制方案预防排斥反应。术后第1天受者24h尿量约5000ml，术后血肌酐逐渐下降，最低下降至180μmol／L，尿蛋白微量。目前受者的移植肾功能恢复良好，仍在随访中。结论移植肾作为供肾再捐赠、移植是可行的，对于缩短尿毒症患者等待肾移植手术的时间及缓解供肾短缺有一定临床意义。

Objective To explore the outcomes of the transplanted kidney as donor for clinical renal transplantation and summarize experience in combination with related literature. Method This study retrospectively analyzed the clinical documents of one case of uremia receiving renal allograft transplantation with the transplanted kidney as the donor in one case of renal transplantation after brain death in February, 2015. The donor was a 31-year-old man who received renal transplantation for uremia in November, 2014 and obtained normal renal function. Two months later, the patient was brain dead because of neurologic disorder and donated his transplanted kidney. The serum creatinine of the donor was 167μmol/L, and the glomerular filtration rate was about 35 mL/min befor donation. The recipient was 27 years old who needed transplantation because of chronic renal function failure and uremia. Preoperation tests showed that PRA was negative, and serum creatinine was 1 353 μmol/L. After separating and dissecting the donor kidney carefully, we perfused and compensated the kidney by Lifeport Organ Perfusion and Preservation Conveyor. The warm ischemia time was about 15 min. The renal vein of the donor was anastomized with right external iliac vein of the receptor, artery with right external iliac artery, and ureter with right centrifugal ureter. Result The operating time was more than 3 h. Postoperatively, the recipient was given the immunosuppressive regimen as tacrolimus, mycophenolate mofetil and methylprednisolone to prevent rejection. At 1st day postoperation, the 24- h urine volume of the receptor was 5 000 mL, serum creatinine was declined gradually to a minimum of 180μmol/L, and there was trace urine proteirL The renal function of patient recovered well by now. Meanwhile, the patient was still under the follow-up. Conclusion It is practical that using transplanted kidney as donor kidney for re-transplantation. There were certain clinical significance for shortening the waiting time of renal transplantation in uremia patients and relieving the shortage of transplant kidney.