Efficacy and safety of low-dose aspirin on preventing transplant renal artery stenosis: a prospective randomized controlled trial

Background:Transplant renal artery stenosis(TRAS)is a vascular complication after kidney transplantation associated with poor outcomes.This study aimed to analyze the efficacy and safety of low-dose aspirin for preventing TRAS.Methods:After kidney transplantation,patients were enrolled from January 2018 to December 2020 in Henan Provincial People’s Hospital.A total of 351 enrolled recipients were randomized to an aspirin group with low-dose intake of aspirin in addition to standard treatment(n=178),or a control group with only standard treatment(n=173).The patients was initially diagnosed as TRAS(id-TRAS)by Doppler ultrasound,and confirmed cases were diagnosed by DSA(c-TRAS).Results:In the aspirin and control groups,15.7%(28/178)and 22.0%(38/173)of the recipients developed id-TRAS,respectively,with no statistical difference.However,for c-TRAS,the difference of incidence and cumulative incidence was statistically significant.The incidence of c-TRAS was lower in the aspirin group compared with the control group(2.8%[5/178]vs.11.6%[20/173],P=0.001).Kaplan–Meier estimates and Cox regression model identified the cumulative incidence and hazard ratio(HR)of TRAS over time in two groups,showing that recipients treated with aspirin had a significantly lower risk of c-TRAS than those who were not treated(log-rank P=0.001,HR=0.23,95%confidence interval[CI]:0.09–0.62).The levels of platelet aggregation rate(P<0.001),cholesterol(P=0.028),and low-density lipoprotein cholesterol(P=0.003)in the aspirin group were decreased compared with the control group in the third-month post-transplantation.For the incidence of adverse events,there was no statistical difference.Conclusion:Clinical application of low-dose aspirin after renal transplant could prevent the development of TRAS with no significant increase in adverse effects.Trial Registration:Clinicaltrials.gov,NCT04260828.

尸肾移植术后移植肾动脉狭窄发病原因分析

目的探讨尸体肾移植术后移植肾动脉狭窄(TRAS)的可能发病原因。方法对尸体肾移植术后18例TRAS患者与未发生TRAS的566受者有可能影响TRAS发生的多个因素进行统计分析。结果(1)TRAS患者的肾移植术后急性排斥反应发生率显著高于非TRAS者(66.67% vs5.48% , P<0.01);(2)发生与未发生TRAS的受者在术前透析方式、糖尿病发病、供肾冷缺血时间、供肾动脉数、供肾侧、供肾动脉吻合方式、术后免疫诱导用药、术后口服免疫维持治疗、术后巨细胞病毒感染以及发病时血脂等诸方面均无显著差异。结论肾移植术后TRAS的发生与移植术后急性排斥反应的发生有密切关系。

嗜铬细胞瘤伴发肾动脉狭窄的临床处理(附2例报告)

目的 :探讨嗜铬细胞瘤并发肾动脉狭窄的临床特点、诊断和治疗。方法 :回顾分析 2例的临床资料 ,并结合文献进行讨论。结果 :10例嗜铬细胞瘤中 2例并发肾动脉狭窄。术前均获确诊。术前用药需结合使用α肾上腺素能受体阻滞剂 (酚苄明 )和血管紧张素转化酶抑制剂 (卡托普利 )。手术方式均为嗜铬细胞瘤摘除加肾动脉黏连松解。术后血压皆恢复正常。结论嗜铬细胞瘤并发肾动脉狭窄术前需诊断全面 ,准备充分 ,并适当计划手术方案 。

移植肾动脉狭窄病因及介入治疗疗效分析

目的探讨移植肾动脉狭窄（TRAS）的病因、介入治疗的疗效及安全性。方法对2000年至2005年经移植肾动脉造影确诊为TRAS的23例患者的临床资料进行回顾性分析。男19例，女4例。年龄23～62岁，平均44岁。23例术后均采用环孢素（CsA）或他克莫司（FK506）加吗替麦考酚酯（MMF）加泼尼松（Pred）三联免疫抑制治疗，其中以CsA治疗为主者14例（60．9％），以FK506治疗为主者9例（39．1％）。结果23例TRAS患者中发生急性排斥反应（AR）者13例（56．5％）；移植肾功能延迟恢复（DGF）者4例（17．4％）；吻合技术原因致吻合口狭窄者1例（4．3％），移植术后1周切除移植肾，再次移植成功；TRAS原因不明者5例（21．7％）。经造影确诊为移植肾动脉狭窄时间为移植术后1周～4年，平均（12±11）个月。单纯吻合口狭窄12例，单纯主干狭窄9例，吻合口并主干狭窄1例，吻合口并受体髂动脉狭窄1例。22例经介入治疗，13例（59．1％）肾功能于1周内恢复，8例（36．4％）2～3周内恢复，1例（4．5％）随访3个月肾功能无变化；造影剂肾毒性导致血肌酐一过性升高者5例，发生移植肾动脉血栓和腹股沟血肿各1例。结论同种异体肾移植术后TRAS与移植肾血管吻合技术、AR及DGF有关。移植肾动脉造影是确诊金标准，一经确诊应立即行球囊扩张或血管内支架治疗，注意并发症的发生。

嗜铬细胞瘤合并肾动脉狭窄

［目的］探讨嗜铬细胞瘤合并肾动脉狭窄的发病机制、肾血管造影的表现，与儿茶酚胺、肾素的关系及对肾血管的作用。［方法］分析个案报告和复习文献。［结果］患者为左肾上腺嗜铬细胞瘤合并双侧肾动脉狭窄，恶性高血压，２４小时尿儿茶酚胺升高，切除肿瘤后血压下降但未降至正常。［结论］本病的发病机制可能为肿瘤压迫或纤维粘连合并儿茶酚胺过度分泌引起的肾动脉可逆或不可逆性狭窄。由于引起肾动脉狭窄的病因不同，血管造影可有不同的表现。与儿茶酚胺的过度分泌及肾动脉狭窄对高血压有不同的致病作用。