Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois 60637, USA.
Curr Opin Crit Care. 2011 Aug;17(4):382-9. doi: 10.1097/MCC.0b013e328348bf1f.
Cardiovascular and renal complications among solid-organ transplant recipients are a frequent source of morbidity. Appropriate management of these complications throughout the perioperative period significantly affects long-term recipient survival. This review details the identification, management, and potential preventive strategies for perioperative cardiovascular and renal complications among solid-organ transplant recipients.
Abdominal transplant candidates have a significantly higher prevalence of risk factors for obstructive coronary artery disease than the general population. There is no consensus on pretransplant screening for coronary artery disease or determination of perioperative risk in candidates awaiting transplantation. Limitations of noninvasive cardiac screening tests such as dobutamine stress echocardiography and myocardial perfusion scintigraphy complicate preoperative evaluation and cardiac risk stratification. Coronary angiography remains the definitive mechanism for determining the presence and severity of coronary artery disease prior to transplantation; however, the relationship between angiographically documented coronary artery disease and cardiovascular morbidity after transplantation is inconsistent. This has raised speculation that perioperative adverse cardiac events are not principally caused by obstructive coronary artery disease but other acute events related to surgical intervention and allograft function. Current data indicate coronary angiography is safe even with patients demonstrating renal insufficiency. A cardiac screening program should reflect the patient population, dynamics of the transplant program, and institutional expertise. The development of classification schemes for defining and categorizing acute kidney injury reflects the importance of preserved renal function in long-term recipient survival. The potential of serum markers as indicators of acute kidney injury has provided a foundation for understanding the global influence of surgical intervention and allograft function upon recipient survival.
Meticulous attention to all aspects of the transplant process, including operative events and early allograft function, is necessary to minimize morbidity. Further research is necessary to identify mechanisms that support and improve early allograft function to optimize recipient long-term survival.
实体器官移植受者的心血管和肾脏并发症是发病率的常见原因。在围手术期对这些并发症进行适当的管理，会显著影响受者的长期存活率。本文详细介绍了实体器官移植受者围手术期心血管和肾脏并发症的识别、管理和潜在的预防策略。
与一般人群相比，腹部器官移植候选者发生阻塞性冠状动脉疾病的危险因素的患病率明显更高。目前对于等待移植的候选者是否需要进行冠状动脉疾病的移植前筛查或确定围手术期风险，尚无共识。负荷超声心动图和心肌灌注闪烁成像等非侵入性心脏筛查试验的局限性使术前评估和心脏风险分层变得复杂。冠状动脉造影仍然是确定移植前是否存在冠状动脉疾病及其严重程度的明确手段；然而，冠状动脉造影诊断的冠状动脉疾病与移植后心血管发病率之间的关系并不一致。这引发了人们的猜测，即围手术期不良心脏事件的主要原因不是阻塞性冠状动脉疾病，而是与手术干预和同种异体移植物功能相关的其他急性事件。目前的数据表明，即使患者表现出肾功能不全，冠状动脉造影也是安全的。心脏筛查计划应反映患者人群、移植计划的动态和机构专业知识。急性肾损伤的定义和分类方案的发展反映了保留肾功能对长期受者存活的重要性。血清标志物作为急性肾损伤指标的潜在可能性为了解手术干预和同种异体移植物功能对受者存活的全球影响提供了基础。
需要对移植过程的各个方面（包括手术事件和早期同种异体移植物功能）给予细致的关注，以最大程度地降低发病率。需要进一步研究以确定支持和改善早期同种异体移植物功能的机制，从而优化受者的长期存活。
