Keller Anna Krarup, Jorgensen Troels Munch, Jespersen Bente
Institute of Clinical Medicine, Aarhus University, Denmark.
J Transplant. 2012;2012:793461. doi: 10.1155/2012/793461. Epub 2012 May 31.
Renal graft survival has improved over the past years, mainly owing to better immunosuppression. Vascular thrombosis, though rare, therefore accounts for up to one third of early graft loss. We assess current literature on transplantation, identify thrombosis risk factors, and discuss means of avoiding thrombotic events and saving thrombosed grafts. The incidence of arterial thrombosis was reported to 0.2-7.5% and venous thrombosis 0.1-8.2%, with the highest incidence among children and infants, and the lowest in living donor reports. The most significant risk factors for developing thrombosis were donor-age below 6 or above 60 years, or recipient-age below 5-6 years, per- or postoperative hemodynamic instability, peritoneal dialysis, diabetic nephropathy, a history of thrombosis, deceased donor, or >24 hours cold ischemia. Multiple arteries were not a risk factor, and a right kidney graft was most often reported not to be. Given the thrombosed kidney graft is diagnosed in time, salvage is possible by urgent reoperation and thrombectomy. Despite meticulous attentions to reduce thrombotic risk factors, thrombosis cannot be entirely prevented and means to an early detection of this complication is desirable in order to save the kidneys through prompt reoperation. Microdialysis may be a new tool for this.
在过去几年中，肾移植的存活率有所提高，这主要归功于更好的免疫抑制措施。血管血栓形成虽然罕见，但却占早期移植肾丢失的三分之一。我们评估了当前关于移植的文献，确定了血栓形成的危险因素，并讨论了避免血栓形成事件和挽救血栓形成移植肾的方法。据报道，动脉血栓形成的发生率为0.2%-7.5%，静脉血栓形成的发生率为0.1%-8.2%，其中儿童和婴儿的发生率最高，活体供肾报告中的发生率最低。发生血栓形成的最显著危险因素是供体年龄低于6岁或高于60岁，或受体年龄低于5-6岁、围手术期或术后血流动力学不稳定、腹膜透析、糖尿病肾病、有血栓形成病史、已故供体或冷缺血时间>24小时。多支动脉不是危险因素，最常报告的是右肾移植也不是危险因素。如果及时诊断出移植肾血栓形成，通过紧急再次手术和血栓切除术有可能挽救移植肾。尽管已精心关注降低血栓形成危险因素，但血栓形成仍无法完全预防，因此需要一种早期检测这种并发症的方法，以便通过及时再次手术挽救肾脏。微透析可能是用于此目的的一种新工具。
