亲属活体供肾小肾癌切除后肾移植一例并文献复习

Living related donor kidney transplantation after resection of a small renal cancer: case report and review of the literature

目的总结亲属活体供肾小肾癌切除后肾移植相关要点和经验。方法回顾性分析2016年1月复旦大学附属中山医院1例亲属活体供肾小肾癌切除后肾移植的临床资料及术后转归。供者为受者母亲,供肾切取术前CT血管造影示右肾下极有一16 mm×15 mm类圆形病灶,考虑右肾小肾癌。经腰十一肋下小切口开放切取供者右肾,供肾切取后进行灌注冲洗,灌注满意后完整切除肿瘤并缝合创面,切除的肿瘤送术中冰冻病理检查,确定无边缘累及后行肾移植术。结果供肾小肾癌术后病理诊断为透明细胞癌,癌组织未侵犯肾被膜。供、受者术后均恢复良好,分别于术后第7、10天出院。受者术中移植肾血流开放前和术后第4天分别应用巴利昔单抗进行诱导治疗,术后3个月内免疫抑制方案为他克莫司+吗替麦考酚酯+醋酸泼尼松,3个月后将他克莫司调整为雷帕霉素。受者术后接受常规随访检查,同时每月接受移植肾彩超检查。截至2016年7月已随访6个月,随访期间移植肾彩超检查未见移植肾占位性病变,移植肾功能稳定。结论通过严格的供肾肿瘤评估及病理学确认,供肾小肾癌切除后可以行活体肾移植,且临床疗效和安全性较好,可作为扩大供肾来源的一种有效途径。

Objective To summarize the experience and key points of living relative kidney transplantation after resection of a small renal cancer. Methods Retrospective analysis was performed on the clinical data and postoperative outcome of a case of living relative kidney transplantation after resection of a small cancer January 2016 in Zhongshan Hospital, Fudan University. The donor was the mother of recipient, CT angiography showed that there was a round spot （ 16 mm x 15 mm） on the bottom of right kidney which was thought to be small renal carcinoma. Donor kidney was harvested through 1 lth-rib supraeostal incision. Then it was washed and perfused with preservation solution. The tumor in the living donor kidney was reseeted and sent for intra-operational pathological examination and the tumor-resected kidney was subsequently used for kidney transplantation after no edge infiltration was confirmed. Results Post-operative pathological examination showed that the histologic type of the tumor was clear cell carcinoma and no carcinoma tissue was found in renal capsule. Basiliximab was used to immunosuppression induction before bloodstream was opened intranperative and 4 days after operation. The immunosuppressive therapy included tacrolimus ＋ mycophenolate ＋ prednisolone in 3 months after operation and tacrolimus switched to rapamycin later. Besides the regulatory examination, the recipient also received doppler ultrasound examination. The recipient was followed for 6 months until July 2016. No space-occupying lesion was found during follow-up and the function of the transplant kidney was stable. Conclusions With strict assessment and pathological confirmation, donor kidneys with a small cancer, once resected, can serve as a donor kidney in transplantation with good expectalions. This may become an effectiw. approach in increasing the source of donor kidney.