Garrido J, Labrador P J, Lerma L, Heras M, García P, Bondía A, Corbacho L, Tabernero M
Servicio de Nefrología, Hospital Clínico Universitario de Salamanca, Salamanca.
Nefrologia. 2004;24 Suppl 3:30-4.
We describe a clinical case of two patients who received a cadaveric renal graft from the same donor in a multi-organ extraction procedure. The donor was a 39-years-old woman who died of intracranial tumour. A benign ganglioma was shown in biopsy. The two recipients received the same immunosuppressive regimen. Induction comprised cyclosporin A, steroids and basiliximab while cyclosporin A and steroids were used in maintenance immunosuppression. The A patient was a 53-year-old woman with chronic renal failure due to chronic pyelonephritis. She had been undergoing periodic haemodialysis for five years. She was hospitalised for sciatic pain refractory to rest and analgesics 35 days after transplantation. Two days later, her graft function deteriorated. Ultrasonography ruled out a urinary tract obstruction. Cyclosporine levels was normal. It was interpreted as an acute rejection episode and was treated with boluses of methylprednisolone (500 mg for 3 days). At the same time, her right leg began to show paraesthesia, coldness and a decreased arterial pulse. A spinal magnetic nuclear resonance was performed. It showed an aneurysm of right common iliac artery (fig. 1). An arteriography confirmed the existence of a pseudoaneurysm and an arteriovenous fistula to inferior vena cava (fig. 2). The B recipient was a 56-year-old woman with chronic renal failure due to chronic pyelonephritis. She required haemodialysis for two years. In the 4th month after transplantation her graft function deteriorated. Graft biopsy did not show acute cellular rejection, so she was kept on immunosuppressive treatment. A second graft biopsy was taken and no changes with the previous one was observed. Renal function deteriorated and haemodialysis was required. During the 6th month she began to show paraesthesia, coldness and decreased arterial pulse in her right leg. Ultrasonography showed pyelocaliectasis with an adjacent solid-liquid mass, abdominal CT scan confirmed. Arteriography proved the presence of a pseudoaneurysm of the right common iliac artery (fig. 3). Transplantectomy and pseudoaneurysm resection was performed in the two cases. Culture analysis revealed fungi identified as Aspergillus in both pseudoaneurysms. Medical treatment was started immediately with liposomal amphotericin B. The clinical evolution of the two recipients were different. While recipient A died, B patient recovered, requiring haemodialysis.
我们描述了两个患者的临床病例，他们在多器官摘取手术中接受了来自同一供体的尸体肾移植。供体是一名39岁死于颅内肿瘤的女性。活检显示为良性神经节瘤。两名受者接受了相同的免疫抑制方案。诱导治疗包括环孢素A、类固醇和巴利昔单抗，维持免疫抑制则使用环孢素A和类固醇。A患者是一名53岁因慢性肾盂肾炎导致慢性肾衰竭的女性。她已经接受了五年的定期血液透析。移植后35天，她因休息和使用止痛剂均无法缓解的坐骨神经痛而住院。两天后，她的移植肾功能恶化。超声检查排除了尿路梗阻。环孢素水平正常。这被解释为急性排斥反应，并给予大剂量甲基泼尼松龙（500毫克，共3天）治疗。与此同时，她的右腿开始出现感觉异常、发冷和动脉搏动减弱。进行了脊柱磁共振成像检查。结果显示右髂总动脉瘤（图1）。血管造影证实存在假性动脉瘤以及与下腔静脉的动静脉瘘（图2）。B受者是一名56岁因慢性肾盂肾炎导致慢性肾衰竭的女性。她需要进行两年的血液透析。移植后第4个月，她的移植肾功能恶化。移植肾活检未显示急性细胞排斥反应，因此她继续接受免疫抑制治疗。进行了第二次移植肾活检，结果与前一次没有变化。肾功能恶化，需要进行血液透析。在第6个月时，她开始出现右腿感觉异常、发冷和动脉搏动减弱。超声检查显示肾盂扩张并伴有相邻的液实性肿块，腹部CT扫描证实了这一点。血管造影证明右髂总动脉瘤存在假性动脉瘤（图3）。两例均进行了移植肾切除术和假性动脉瘤切除术。培养分析显示两个假性动脉瘤中均发现了被鉴定为曲霉菌的真菌。立即开始使用脂质体两性霉素B进行药物治疗。两名受者的临床病程不同。A受者死亡，而B患者康复，但需要进行血液透析。
