供者来源侵袭性移植肾真菌感染12例报告

Clinical analysis of 12 cases in invasive renal graft of deep fungal infection

目的探讨供者来源侵袭性移植肾真菌感染的临床特点，总结临床诊治经验。方法回顾性分析2011年2月到2016年1月117例DCD供者供肾移植的临床资料，其中12例受者术后发生供者来源侵袭性移植肾深部真菌感染，12只供肾来源于6例供者。对12例发生真菌感染受者的危险因素和临床表现进行总结。结果所有受者均有不同程度的移植肾功能恢复延迟，4例有发热，3例有尿频、尿急、尿痛等泌尿系症状，其余均无特异性临床表现。12例受者发生真菌感染的时间为12-56d，检出毛霉菌4例、念珠菌属4例及曲霉菌4例，接受同一供者供肾的2例受者均为同一真菌感染；4例死亡（其中2例带移植肾功能死亡），3例移植肾切除后进行了人工血管搭桥术，除带移植肾功能死亡的受者外其余受者均切除了移植肾恢复血液透析。结论临床应注意供者来源的真菌感染，高度怀疑时应早期外科干预，保障受者安全。

Objective To investigate the clinical features of donor-derived invasive fungal infection, and to summarize the experience of clinical diagnosis and treatment. Methods To analyse retrospectively clinical data of 117 patients with DCD donor kidney transplantation from February 2011 to January 2016, in which 12 recipients derived from 6 donors were infected fungal infections, the risk factors and clinical manifestations of 12 cases were summarized. Results All recipients had different degrees of delayed graft function. 4 cases had fever, 3 cases had frequent micturition, urgency and dysuria and other urinary symptoms, the others had no special clinical manifestation, in 12 cases the time of fungal infection was d 12- 56, and detected 4 cases of hairy fungus, 4 cases of Candida species and 4 cases of Aspergillus, The same fungal infection was derived in 2 recipients who received the same donor kidney; 4 cases died （2 cases died with transplanted kidney）. 3 cases were replaced the external lension ateery with blood vessel prosthesis after removal of transplanted kidney. In addition to the death of recipients with functional graft, the remaining recipients were removed transplanted kidney and restored hemodialysis. Conclusion Fungal infection of the donor origin should be noted, for highly suspected cases, early surgical intervention should be taken to ensure the safety of the recipients.