Yang M-H, Loong C-C, Wu C-W, Lui W-Y
Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan.
Transplant Proc. 2008 Sep;40(7):2437-9. doi: 10.1016/j.transproceed.2008.07.044.
Late spontaneous kidney graft decapsulation with fluid collection is a rare condition with only a few cases reported in the literature. Common causes of renal allograft rupture include acute rejection, acute tubular necrosis, renal vein thrombosis, and trauma. Sirolimus related late spontaneous decapsulation has not been reported in the past. Interestingly, sirolimus may promote lymphocele formation in renal transplant recipients, including those presenting with chronic hepatitis B or C. Herein, we report a case of late spontaneous decapsulation with subcapsular hematoma formation developing 12 years after receipt of a cadaveric allograft. The patient was infected with both hepatitis B and C viruses. Cyclosporine was replaced by sirolimus for maintenance therapy because of chronic rejection and acute deterioration of renal function. He presented to the hospital at 9 months after sirolimus inception because of a sudden onset of pain and swelling over the kidney graft. Magnetic resonance imaging found the capsule to be stripped from the kidney by a collection of liquefied hematomas. A laparoscopic fenestration was performed by creation of a peritoneal window adjacent to the renal allograft. When patients have chronic hepatitis, tacrolimus might be a better choice than sirolimus.
晚期自发性肾移植包膜剥脱伴积液是一种罕见疾病，文献中仅有少数病例报道。同种异体肾移植破裂的常见原因包括急性排斥反应、急性肾小管坏死、肾静脉血栓形成和创伤。西罗莫司相关的晚期自发性包膜剥脱过去尚未见报道。有趣的是，西罗莫司可能会促进肾移植受者形成淋巴囊肿，包括那些患有慢性乙型或丙型肝炎的受者。在此，我们报告一例在接受尸体同种异体移植12年后发生的晚期自发性包膜剥脱伴包膜下血肿形成的病例。该患者同时感染了乙型和丙型肝炎病毒。由于慢性排斥反应和肾功能急性恶化，环孢素被西罗莫司替代用于维持治疗。在开始使用西罗莫司9个月后，他因肾移植部位突然出现疼痛和肿胀而入院。磁共振成像发现包膜被液化血肿聚集物从肾脏上剥离。通过在肾同种异体移植附近创建一个腹膜窗口进行了腹腔镜开窗术。当患者患有慢性肝炎时，他克莫司可能比西罗莫司是更好的选择。
