Cardiovascular Surgery Department, University Hospital of Saint-Etienne, 42055, Saint-Etienne Cedex 2, France.
Pediatric Department, University Hospital of Saint-Etienne, 42055, Saint-Etienne Cedex 2, France.
Pediatr Nephrol. 2017 Oct;32(10):1935-1940. doi: 10.1007/s00467-017-3664-x. Epub 2017 Apr 20.
This study describes the long-term results of renal autotransplantation for renovascular hypertension performed in children who are now 21 years of age or older.
Sixteen children (4 boys, 12 girls) with a mean age of 11.2 years at the time of the procedure underwent ex-vivo surgery at the university hospital of Saint-Etienne between 1992 and 2008. Acetylsalicylic acid was used for antiplatelet therapy in the postoperative period, without routine anticoagulation. The mean follow-up period was 15 years. The clinical course of these patients was retrospectively reviewed in adulthood and the results analyzed.
The children were treated with a mean of 2.37 drugs per patient, and the mean preoperative blood pressure of the entire patient population was 151/89 mmHg. Mean preoperative creatinine clearance was 80 ml/min/1.73 m. There was no postoperative death. One patient experienced a thrombosis immediately after the surgery, leading to a redo surgery. In this patient diuresis was restarted, but without efficient concentration and filtration, ultimately leading the patient to have a renal transplant after 1 year. At the end of the follow-up period, eight of the 16 patients (50%) were cured and the others were improved. At the last follow-up the mean blood pressure was 127/70 mmHg, and the mean number of drugs per patient was 0.68. The mean creatinine clearance at last follow-up was 104.3 ml/min/1.73 m. Three patients had secondary procedures, with two undergoing percutaneous angioplasty (at postoperative months 9 and 12, respectively) and one having an hepatorenal bypass at postoperative year 4. Primary patency was 12/16 (75%); primary assisted patency was 15/16 (94%); secondary patency was 16/16 (100%).
This study shows that renal autotransplantation has good and stable long-term results and is an effective conservative strategy for treating renovascular hypertension in children, thus avoiding nephrectomy.
本研究描述了在圣艾蒂安大学医院进行的儿童肾自体移植治疗肾血管性高血压的长期结果，这些儿童现在已经 21 岁或以上。
1992 年至 2008 年期间，16 名儿童（4 名男孩，12 名女孩）在该大学医院接受了离体手术，平均年龄为 11.2 岁。术后使用乙酰水杨酸进行抗血小板治疗，不常规抗凝。平均随访时间为 15 年。这些患者在成年后回顾了他们的临床病程，并对结果进行了分析。
儿童患者平均每人接受 2.37 种药物治疗，整个患者人群的术前平均血压为 151/89mmHg。术前平均肌酐清除率为 80ml/min/1.73m。术后无死亡病例。1 例患者术后即刻发生血栓，导致再次手术。在该患者中，利尿重新开始，但无有效浓缩和过滤，最终导致该患者在 1 年后进行了肾移植。在随访结束时，16 名患者中有 8 名（50%）治愈，其余患者有所改善。在最后一次随访时，平均血压为 127/70mmHg，平均每位患者的药物数量为 0.68。最后一次随访时的平均肌酐清除率为 104.3ml/min/1.73m。3 名患者进行了二次手术，其中 2 名分别在术后第 9 个月和第 12 个月接受了经皮血管成形术，1 名在术后第 4 年接受了肝肾旁路术。原发性通畅率为 12/16（75%）；原发性辅助通畅率为 15/16（94%）；继发性通畅率为 16/16（100%）。
本研究表明，肾自体移植具有良好且稳定的长期效果，是治疗儿童肾血管性高血压的一种有效保守策略，从而避免了肾切除术。
