Kashi S H, Lodge J P, Giles G R, Irving H C
University Department of Surgery, St James's University Hospital, Leeds, UK.
Nephrol Dial Transplant. 1991;6(5):358-62. doi: 10.1093/ndt/6.5.358.
Reports and ultrasound scans (658 studies) of 135 renal allografts, transplanted in the years 1987 and 1988, have been reviewed. Records of the recipients were also studied in order to determine the clinical status of the kidney at the time of each ultrasound examination and to obtain long-term follow-up of allograft function. Seventy-seven allografts (57%) never showed pelvicalyceal dilatation on 342 serial examinations. Forty-two kidneys (31%) had mild dilatation reported on at least one scan, which did not progress. However, 11 mildly dilated allografts developed moderate to severe dilatation on later examinations and these, together with 5 allografts reported as exhibiting moderate to severe hydronephrosis on their first dilated scan, were classed as moderate to severe (n = 16 = 12%). Thirty-eight patients (90%) with mild dilatation of the collecting system had no evidence of obstruction. However, in allografts with moderate to severe dilatation and poor or deteriorating function, ten patients (70%) were found to have ureteric obstruction. There was no significant difference in 1-year graft survival (87% versus 81.8%) and the median serum creatinine at 3 and 12 months after transplantation between non obstructed 'dilated' and non-dilated allografts (149 mumol/l versus 153.7 mumol/l; 139 mumol/l versus 147.3 mumol/l). All 14 obstructed allografts were salvaged with a graft survival of 85.7% at 1 year. Median serum creatine in these patients was significantly elevated at 200 mumol/l and 189 mumol/l at 3 and 12 months; P = 0.05 and 0.01 compared to dilated non-obstructed allografts. Our results indicate that grafts with moderate to severe dilatation should be urgently investigated to minimise further allograft damage.
对1987年和1988年移植的135个同种异体肾移植的报告及超声扫描（658项研究）进行了回顾。还对受者的记录进行了研究，以确定每次超声检查时肾脏的临床状况，并获得同种异体肾移植功能的长期随访结果。在342次连续检查中，77个同种异体肾移植（57%）从未出现肾盂肾盏扩张。42个肾脏（31%）至少在一次扫描中报告有轻度扩张，且未进展。然而，11个轻度扩张的同种异体肾移植在随后的检查中发展为中度至重度扩张，这些以及5个在首次扩张扫描时报告为中度至重度肾积水的同种异体肾移植被归类为中度至重度（n = 16 = 12%）。38例（90%）集合系统轻度扩张的患者没有梗阻证据。然而，在中度至重度扩张且功能差或恶化的同种异体肾移植中，10例患者（70%）被发现有输尿管梗阻。未梗阻的“扩张”同种异体肾移植与未扩张的同种异体肾移植在移植后1年的移植物存活率（87%对81.8%）以及移植后3个月和12个月时的血清肌酐中位数（149μmol/L对153.7μmol/L；139μmol/L对147.3μmol/L）方面没有显著差异。所有14个梗阻的同种异体肾移植均成功挽救，1年时移植物存活率为85.7%。这些患者在3个月和12个月时血清肌酐中位数显著升高，分别为200μmol/L和189μmol/L；与未梗阻的扩张同种异体肾移植相比，P = 0.05和0.01。我们的结果表明，应紧急对中度至重度扩张的移植物进行检查，以尽量减少同种异体肾移植的进一步损害。
