Ruiz Mercedes, Hevia Vital, Fabuel Jose-Javier, Fernández Alvaro-Amancio, Gómez Victoria, Burgos Francisco-Javier
Urology Department, Hospital Ramón y Cajal, IRYCIS, Alcalá University, Ctra Colmenar km 9,100, 28034, Madrid, Spain.
Int Urol Nephrol. 2017 Nov;49(11):1929-1935. doi: 10.1007/s11255-017-1680-1. Epub 2017 Aug 21.
To analyze indications, surgical technique, complications and long-term outcomes of kidney autotransplantation (KAT) after 26-year experience at a single institution.
A retrospective observational study of patients who underwent KAT at our institution (January 1990-December 2016) was carried out. Data collected included indications, surgical technique, complications (Clavien-Dindo), hospital stay and long-term outcomes. Literature review was performed through MEDLINE and ClinicalKey databases including "kidney," "renal," "autotransplantation" and "autograft."
Fifteen patients underwent a KAT, with a mean age of 41 years (range 34-59). Indications were vascular abnormalities in 8 cases and ureteral injury in 7. Nephrectomy was performed through laparoscopy in 2 cases (13.3%) and open in 13 (86.7%). Vascular grafts to reperfuse the kidney were used in 8 patients, and ureteral reimplantation was performed in 11 cases. Mean hospital stay was 9.1 days (range 3-20). Seven patients (46.7%) developed postoperative complications: 6 minor (Clavien I-II) and 1 major (Clavien III). After a mean follow-up of 73.1 months (range 7-312), 80% of the patients have a functioning graft. Most common indication reported in the literature is ureteral stricture, especially in the most recent years. Graft survival is variable, and complications are frequent, but usually minor.
KAT is an effective treatment for complex ureteral lesions and kidney vascular abnormalities, with good results in the long term. Surgical complications are frequent, but usually minor. As a challenging surgery, it should be performed by experienced kidney transplant surgeons. Complex and proximal ureteral injuries are nowadays the main indication of this procedure.
分析在单一机构26年经验基础上的自体肾移植（KAT）的适应证、手术技术、并发症及长期疗效。
对在我院（1990年1月至2016年12月）接受KAT的患者进行回顾性观察研究。收集的数据包括适应证、手术技术、并发症（Clavien-Dindo分级）、住院时间及长期疗效。通过MEDLINE和ClinicalKey数据库进行文献检索，检索词包括“肾”“肾脏”“自体移植”和“自体移植物”。
15例患者接受了自体肾移植，平均年龄41岁（范围34 - 59岁）。适应证为血管异常8例，输尿管损伤7例。2例（13.3%）通过腹腔镜进行肾切除术，13例（86.7%）通过开放手术进行。8例患者使用血管移植物使肾脏再灌注，11例患者进行了输尿管再植术。平均住院时间为9.1天（范围3 - 20天）。7例患者（46.7%）发生术后并发症：6例为轻度（Clavien I-II级），1例为重度（Clavien III级）。平均随访73.1个月（范围7 - 312个月）后，80%的患者移植肾仍有功能。文献报道最常见的适应证是输尿管狭窄，尤其是近年来。移植肾存活率各不相同，并发症常见，但通常为轻度。
自体肾移植是治疗复杂输尿管病变和肾脏血管异常的有效方法，长期效果良好。手术并发症常见，但通常为轻度。作为一项具有挑战性的手术，应由经验丰富的肾移植外科医生进行。复杂和近端输尿管损伤如今是该手术的主要适应证。
