Peregrin J H, Bürgelová M
Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
Cardiovasc Intervent Radiol. 2009 May;32(3):548-53. doi: 10.1007/s00270-008-9420-7. Epub 2008 Aug 28.
This study is the report of a 37-year-old male with a transplanted kidney from a 3.5-year-old donor: the graft had two arteries transplanted with an aortic patch to an external iliac artery. Four months after transplantation, the graft function deteriorated, together with the development of hypertension. Stenosis of both graft arteries was detected and the patient was referred for angioplasty. The angiographic result was suboptimal, nevertheless, the graft function improved and was more or less stable (serum creatinine, 160-200 micromol/l) for 4 years, along with persistently difficult-to-control hypertension. Five years after transplantation, the graft function deteriorated again and severe graft artery restenosis was detected. The restenosis did not respond to dilatation, graft function failed, hypertension decompensated, and left ventricular failure developed. The patient required dialysis. A cutting balloon angioplasty opened the artery, and kidney function was restored after a few days: the serum creatinine level dropped to 140-160 micromol/l, and the glomerular filtration rate (creatinine clearance) to 0.65 ml/min/1.73 m(2). The graft function has now been stable for more than 2 years, however, the hypertension is still difficult to control.
本研究报告了一名37岁男性，其移植肾来自一名3.5岁的供体：移植肾有两条动脉，通过主动脉补片移植至髂外动脉。移植后4个月，移植肾功能恶化，同时出现高血压。检测到两条移植肾动脉均发生狭窄，患者被转诊接受血管成形术。血管造影结果并不理想，不过，移植肾功能有所改善，并且在4年时间里或多或少保持稳定（血清肌酐为160 - 200微摩尔/升），同时高血压一直难以控制。移植后5年，移植肾功能再次恶化，检测到严重的移植肾动脉再狭窄。再狭窄对扩张治疗无反应，移植肾功能衰竭，高血压失代偿，并发左心室衰竭。患者需要进行透析。切割球囊血管成形术使动脉开通，几天后肾功能恢复：血清肌酐水平降至140 - 160微摩尔/升，肾小球滤过率（肌酐清除率）降至0.65毫升/分钟/1.73平方米。目前移植肾功能已稳定超过2年，然而，高血压仍然难以控制。
