Ferris Robert L, Kittur Dilip S, Wilasrusmee Chumpon, Shah Gaurang, Krause Edward, Ratner Lloyd
Department of Surgery, Division of Transplant Surgery, The Johns Hopkins University School of Medicine, New York, USA.
Med Sci Monit. 2003 Feb;9(2):CR61-6.
Transplantation of organs leads to several physiologic changes in the recipients who, during their anephric state on chronic hemodialysis, have increased total body water and several electrolyte imbalances. Several abnormal parameters are observed in the physiology of the renal recipient. The central venous pressure (CVP) in the recipient invariably declines despite vigorous fluid resuscitation for reasons that are not clear at the present time.
MATERIAL/METHODS: We studied 77 kidney transplants retrospectively, in which we observed a significant decline in central venous pressure (CVP) in the immediate posttransplant period. This phenomenon occurred despite aggressive fluid management and positive fluid balances averaging nearly four liters. Our analysis included the time course of the phenomenon itself as well as a detailed comparison of various parameters in the recipient and the renal graft for possible correlation with this consistent decline in CVP.
Neither the absolute CVP nor the drop in CVP appeared to influence the rate of ATN. Interestingly, we found that the kinetics of the decline in CVP were remarkably similar in recipients of both cadaveric and living-related kidneys.
This finding suggests that the reperfusion injury or a related effect may be responsible for the clinical phenomenon presented in this study.
器官移植会给受者带来多种生理变化，这些受者在慢性血液透析的无肾状态下，全身总水量增加且存在多种电解质失衡。肾移植受者的生理机能出现了一些异常参数。尽管进行了积极的液体复苏，但受者的中心静脉压（CVP）始终下降，目前原因尚不清楚。
材料/方法：我们回顾性研究了77例肾移植病例，观察到移植后即刻中心静脉压（CVP）显著下降。尽管进行了积极的液体管理且液体正平衡平均接近4升，但这一现象仍会出现。我们的分析包括该现象本身的时间进程，以及对受者和肾移植相关的各种参数进行详细比较，以找出与CVP持续下降可能相关的因素。
绝对CVP和CVP下降幅度似乎均未影响急性肾小管坏死的发生率。有趣的是，我们发现尸体肾和亲属活体肾受者CVP下降的动力学非常相似。
这一发现表明，再灌注损伤或相关效应可能是本研究中所呈现临床现象的原因。
