Barth M O, Gagnadoux M F, Mareschal J L, Garel L, Mamou-Mani T, Brunelle F O
Service de Radiologie pédiatrique, Hopital des Enfants-Malades, Paris, France.
Pediatr Radiol. 1989;19(6-7):383-7. doi: 10.1007/BF02387633.
Systemic hypertension after renal transplantation in children is frequent, occurring in 85% of the cases and may be the cause of severe neurologic complications. This can be due to multiple factors such as: rejection, recurrence of initial disease, steroid, etc. ... Among those factors, renal transplant artery stenosis (RTAS) must be identified as it may be cured by angioplasty. We report our experience in 18 children who had undergone angioplasty for RTAS. Angioplasty was performed under general anesthesia with 3F, 4F or 5F balloon catheters. Angioplasty was successful in 14 cases (77%) immediately (10 cases), progressively (2 cases) or after a successfully redilated recurrence (2 cases). Two of the 4 failures were due to technical problems, a successful surgical treatment was then performed. The 2 others failures were explained by a severe transplant rejection. The complications were rare: 1 femoral artery thrombosis and spasms of the intra renal arteries but without repercussion on the renal function. In our experience, angioplasty seems to be the treatment of choice in RTAS in children. However the indications must be carefully established taking in account other possible causes of hypertension in such patients.
儿童肾移植后系统性高血压很常见，发生率为85%，可能是严重神经并发症的原因。这可能归因于多种因素，如：排斥反应、原发病复发、类固醇等……在这些因素中，肾移植动脉狭窄（RTAS）必须被识别出来，因为它可以通过血管成形术治愈。我们报告了18例因RTAS接受血管成形术的儿童的经验。血管成形术在全身麻醉下使用3F、4F或5F球囊导管进行。血管成形术立即成功14例（77%）（10例）、逐渐成功（2例）或在成功再次扩张复发后成功（2例）。4例失败中有2例是由于技术问题，随后进行了成功的手术治疗。另外2例失败是由于严重的移植排斥反应。并发症很少见：1例股动脉血栓形成和肾内动脉痉挛，但对肾功能无影响。根据我们的经验，血管成形术似乎是儿童RTAS的首选治疗方法。然而，必须仔细确定适应症，同时考虑此类患者高血压的其他可能原因。
