Stippel D L, Bangard C, Schleimer K, Koerber F, Beckurts K T E, Hoppe B
Department of Visceral and Vascular Surgery, University of Cologne, Cologne, Germany.
Transplant Proc. 2006 Apr;38(3):688-90. doi: 10.1016/j.transproceed.2006.01.068.
An 8-year-old girl who was born premature in the 24th gestational week suffered a septic venous thrombosis due to an indwelling central line during the early perinatal period. As a result the inferior vena cava including the intrahepatic segment and both iliac veins was obliterated. The right kidney was primarily dysplastic, and the left kidney developed a partial infarction. Renal function was compensated until the age of 6 years. Magnetic resonance angiography at that time showed a collateral system via the azygos vein. The venous pressure and its variation with breathing as measured invasively showed normal values. During pretransplant initiation of immunosuppressive therapy, the child developed cerebral convulsions after the third dose of cyclosporine. Therefore we utilized a regimen of rapamycin, mycophenolate mofetil, and steroids. The transplantation was performed using a living donor graft from the child's mother. The relatively long vein from the left kidney was used for anastomosis with a large presacral collateral vein. Twelve months after transplantation the kidney function is stable with a serum creatinine of 0.5 mg/dL. The recipient thrombosis of the caval and iliac veins is not a principal contraindication for successful renal transplantation. MR angiography and invasive pressure measurements facilitated evaluation of the collateral venous system. The living donation setting allowed the initiation of an immunosuppressive regimen that was tailored to the concomitant diseases of the child.
一名在孕24周时早产的8岁女孩在围产期早期因留置中心静脉导管发生了感染性静脉血栓形成。结果，包括肝内段和双侧髂静脉在内的下腔静脉闭塞。右肾原发性发育不良，左肾发生部分梗死。肾功能在6岁前得到代偿。当时的磁共振血管造影显示通过奇静脉形成了一个侧支循环系统。有创测量的静脉压力及其随呼吸的变化显示为正常值。在移植前开始免疫抑制治疗期间，患儿在第三次服用环孢素后出现了脑惊厥。因此，我们采用了雷帕霉素、霉酚酸酯和类固醇的治疗方案。移植使用了来自患儿母亲的活体供肾。来自左肾的相对较长的静脉用于与骶前一条较大的侧支静脉进行吻合。移植后12个月，肾功能稳定，血清肌酐为0.5mg/dL。受者的腔静脉和髂静脉血栓形成并非肾移植成功的主要禁忌证。磁共振血管造影和有创压力测量有助于评估侧支静脉系统。活体供肾的情况使得能够启动针对患儿伴发疾病量身定制的免疫抑制方案。
