移植肾动脉狭窄腔内治疗的近中期疗效

Mid-term results of endovascular intervention for transplant renal artery stenosis

目的分析腔内治疗移植肾动脉狭窄(transplant renal artery stenosis,TRAS)的临床效果。方法回顾性分析2014年1月至2021年1月于郑州大学第一附属医院肾移植科进行肾移植术后出现TRAS并接受了血管腔内治疗的患者的临床资料及中期随访结果。结果共2 230例患者进行了肾移植,其中78例发生TRAS,发生率为3.6%,27例患者接受了血管腔内治疗并得到12~80个月的随访,中位随访时间36个月。13例(48.1%)进行了移植肾动脉造影并球囊扩张术,其中2例因再狭窄而行支架置入术,14例(51.9%)进行了移植肾动脉造影球囊扩张并支架置入术。患者术前血清肌酐217.1 μmol/L(98~541 μmol)与术后2周127.6 μmol/L(47~220 μmol/L)和术后12个月103.4 μmol/L(63~166 μmol/L)相比,术后血清肌酐明显降低(P<0.05);术前肾小球滤过率42.7 ml/min(8.3~105.3 ml/min)与术后2周61.8 ml/min(24.6~132.2 ml/min)和术后1年76.3 ml/min(47.3~113.9 ml/min)相比,术后肾小球滤过率明显升高(P<0.05)。移植肾动脉收缩期峰值血流速度(PSV),术前为234 cm/s(75~457 cm/s),术后2周为129 cm/s(52~290 cm/s)(P<0.05),1年后为118 cm/s(57~300 cm/s)(P<0.05)。随访期间,2例(7.4%)因肺部感染导致的多脏器衰竭而死亡。结论 TRAS是肾移植术后最常见的血管并发症,血管腔内治疗手术成功率高,并发症发生率低。

Objective To evaluate the mid-term results of endovascular treatment for transplant renal artery stenosis(TRAS).Methods The clinical and follow-up data of TRAS patients undergoing endovascular treatment at the First Affiliated Hospital of Zhengzhou University from Jan 2014 to Jan 2021 were retrospectively analyzed.Results A total of 2230 patients underwent kidney transplantation,78 cases(3.6%)developed TRAS,among those 27 patients received endovascular treatment and followed-up from 12 to 80 months(mean 36 months).Thirteen patients(48.1%)underwent renal graft angiography and balloon dilatation,of which 2 patients underwent stent placement,14 patients(51.9%)underwent renal graft angiography with balloon dilatation and stenting.The serum creatinine 2 weeks postoperatively and 12 months postoperatively were 127.6μmol/L(47-220μmol/L)and 103.4μmol/L(63-166μmol/L),respectively,significantly lower than the preoperative 217.1μmol/L(98-541μmol/L),(P<0.05).Glomerular filtration rate(GFR)before surgery was 8.3-105.3 ml/min,2 weeks and 12 months after surgery compared to 24.6-132.2 ml/min and 47.3-113.9 ml/min(P<0.05).The preoperative peak systolic velocity(PSV)of the transplanted renal artery during the systolic phase was 234 cm/s(75-457 cm/s),compared to 129 cm/s(52-290 cm/s)(P<0.05)2 weeks and 118 cm/s(57-300 cm/s)12 months postoperatively(P<0.05).During the follow-up period,2 patients(7.4%)died of multiple organ failure.Conclusions TRAS is the most common vascular complication after kidney transplantation.Endovascular treatment has a high success rate and low complication rate.