Toronyi Eva, Máthé Zsolt, Chmel Rita, Varga Marina, Kozma Veronika, Trent Roland, Tozsér Gellért, Nagy Gergely, Langer Róbert
Semmelweis Egyetem Transzplantációs és Sebészeti Klinika 1082 Budapest Baross u. 23-25.
Magy Seb. 2011 Oct;64(5):229-34. doi: 10.1556/MaSeb.64.2011.5.2.
Kidney transplantation is the optimal treatment of end stage kidney disease. The most common vascular complication in the early postoperative period is thrombosis of the renal artery and vein. These complications usually lead to the loss of the transplanted kidney.
of our study was to identify those factors which represent an increased risk for thrombotic complication and determine whether routine screening for thrombophilia is justifiable before transplantation. As an illustration to this problem we report a case of successful renal vein recanalisation after thrombosis.
We give an overview of the literature about incidence of renal graft thrombosis, hypercoagulable states, predictive value of factor V. Leiden and prothrombin G20210A mutations in venous thromboembolism. We discuss those publications that suggest a preoperative screening of transplant candidates for hypercoagulable states and thrombophilia and those that do not think that such screening is reasonable. In our case a 28 year old male patient received a cadaveric kidney. Thrombosis of the renal vein was diagnosed 8 hours after transplantation. Reoperation was performed immediately: venous anastomosis was opened, the thrombus removed. After reoperation the circulation of the kidney recovered, intravenous heparin treatment was introduced immediately.
24 months later the kidney is still functioning well. Postoperative thrombophilia screening showed heterozygosity for factor V Leiden.
There are only few publications reporting on successful recanalisation after renal vein thrombosis. In our case rapid diagnosis and immediate operative treatment saved the graft. There is no uniform proposal in the literature whether preoperative screening for thrombophilia is justifiable or not. In our view screening for thrombophilia and thromboprophylaxis is mandatory. Extensive prospective studies should be undertaken to refine the risks and establish the associations of thrombophilia and thromboembolism after kidney transplantation.
肾移植是终末期肾病的最佳治疗方法。术后早期最常见的血管并发症是肾动静脉血栓形成。这些并发症通常会导致移植肾丧失。
我们研究的目的是确定那些代表血栓形成并发症风险增加的因素，并确定移植前常规筛查易栓症是否合理。作为这个问题的一个例证，我们报告一例血栓形成后成功进行肾静脉再通的病例。
我们概述了有关肾移植血栓形成的发生率、高凝状态、因子V莱顿突变和凝血酶原G20210A突变在静脉血栓栓塞中的预测价值的文献。我们讨论了那些建议对移植候选者进行高凝状态和易栓症术前筛查的出版物，以及那些认为这种筛查不合理的出版物。在我们的病例中，一名28岁男性患者接受了尸体肾移植。移植后8小时诊断为肾静脉血栓形成。立即进行再次手术：打开静脉吻合口，清除血栓。再次手术后肾脏血液循环恢复，立即开始静脉肝素治疗（静脉内注射肝素）。
24个月后，肾脏仍功能良好。术后易栓症筛查显示因子V莱顿杂合子。
仅有少数文献报道肾静脉血栓形成后成功再通的情况。在我们的病例中，快速诊断和立即手术治疗挽救了移植肾。文献中对于术前筛查易栓症是否合理尚无统一建议。我们认为易栓症筛查和血栓预防是必要的。应进行广泛的前瞻性研究，以明确风险并建立肾移植后易栓症与血栓栓塞之间的关联。
