围手术期移植肾切除的临床分析

The causes and prognosis of allograft nephrectomy during the perioperative period

目的分析肾移植术后早期移植肾切除的原因及转归。方法回顾性分析2009年1月至2017年5月施行的移植肾早期切除的11例患者的临床资料。分析移植肾切除原因,并观察移植肾切除后并发症发生及转归以及后续是否再次肾移植。结果对所有受者随访6~48个月,移植肾切除原因包括超急性排斥反应2例,移植肾血栓2例,移植肾感染破裂4例,出血切除3例;3例患者死亡,其余8例恢复透析治疗;术前群体反应性抗体(PRA)均不同程度升高,患者远期都未能行肾移植手术,原因包括群体反应性抗体较高、手术打击太大丧失信心、费用问题。结论移植肾早期切除原因包括超急性排斥反应、血栓形成、移植肾感染,切除后后期再移植率低。

Objective To analyze the reason of renal allograft resection after kidney transplantation and after the prognosis.Methods Retrospectively analysis of data of eleven cases involved with early resection of kidney transplantation from January 2009 to May 2017 was performed.The causes of nephrectomy,the complications and prognosis after nephrectomy as well as the subsequent renal transplantation were collected.Results All the patients were followed up for 6-48 months.The reasons for the nephrectomy included hyper acute rejection(2 cases),kidney artery/vein thrombosis(2 cases),kidney infection(4 cases)and bleeding(3 cases).Three patients died,and the remaining 8 patients returned to dialysis.The PRA had been elevated to a high level with different degree.The patient had no will to perform the kidney transplant again during the follow-up period.The reasons included the higher PRA,the loss of confidence for the operation,and the cost.Conclusions The reasons for the early resection of kidney transplantation include HAR,renal artery/vein thrombosis,transplantation of kidney infection.The rate of retransplantation is very low after the failure of the first kidney transplantation.