Mikhalski Dimitri, Wissing Karl Martin, Bollens Renaud, Abramowicz Daniel, Donckier Vincent, Hoang Anh-Dung
Department of Digestive Surgery and Transplantation, Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium.
Case Rep Transplant. 2011;2011:153493. doi: 10.1155/2011/153493. Epub 2011 Jul 28.
Advanced atherosclerosis or thrombosis of iliac vessels can constitute an absolute contraindication for heterotopic kidney transplantation. We report the case of a 42-year-old women with end-stage renal disease due to lupus nephritis and a history of bilateral thrombosis of iliac arteries caused by antiphospholipid antibodies. Occlusion had been treated by the bilateral placement of wall stents which precluded vascular anastomosis. The patient was transplanted with a right kidney procured by laparoscopic nephrectomy from her HLA semi-identical sister. The recipient had left nephrectomy after laparoscopical transperitoneal dissection. The donor kidney was orthotopically transplanted with end-to-end anastomosis of graft vessels to native renal vessels and of the graft and native ureter. Although, the patient received full anticoagulation because of a cardiac valve and antiphospholipid antibodies, she had no postoperative complication in spite of a short period of delayed graft function. Serum creatinine levels three months after transplantation were at 1.0 mg/dl. Our case documents that orthotopical transplantation of laparoscopically procured living donor kidneys at the site of recipient nephrectomy is a feasible procedure in patients with surgical contraindication of standard heterotopic kidney transplantation.
髂血管严重动脉粥样硬化或血栓形成可构成异位肾移植的绝对禁忌证。我们报告了一例42岁女性患者，因狼疮性肾炎导致终末期肾病，并有抗磷脂抗体引起的双侧髂动脉血栓形成病史。此前通过双侧放置血管支架治疗闭塞，这使得血管吻合无法进行。患者接受了来自其HLA半相合姐妹的经腹腔镜肾切除术获取的右肾移植。受者在腹腔镜经腹解剖后进行了左肾切除术。供肾原位移植，将移植肾血管与受者肾血管进行端端吻合，并将移植肾输尿管与受者输尿管吻合。尽管由于心脏瓣膜病和抗磷脂抗体患者接受了充分抗凝治疗，但尽管移植肾功能有短暂延迟，她术后仍未出现并发症。移植后三个月血清肌酐水平为1.0mg/dl。我们的病例表明，对于标准异位肾移植存在手术禁忌证的患者，在受者肾切除部位原位移植经腹腔镜获取的活体供肾是一种可行的手术方法。
