Sasaki H, Nakazawa R, Iwata T, Usuba W, Yoshie H, Fujimoto E, Metoki H, Katsuoka Y, Aida K, Kudo H, Koitabashi K, Yazawa M, Shibagaki Y, Marui Y, Chikaraishi T
Department of Urology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.
Department of Urology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.
Transplant Proc. 2017 Dec;49(10):2388-2391. doi: 10.1016/j.transproceed.2017.09.008.
In recent years, the frequency of high-risk kidney transplantations has increased. We report a case in which a 72-year-old man with various severe comorbidities (prostate cancer, diabetes mellitus, complete atrioventricular block, coronary artery stenosis, severe stenosis of the popliteal arteries, and severe calcification of the iliac arteries) who received an orthotopic kidney transplantation. To prevent the occurrence of acute limb ischemia due to the steal phenomenon (caused by the kidney graft), we decided that a heterotopic kidney transplantation involving the iliac arteries was not an appropriate option. Therefore, as an alternative, left native nephrectomy was performed followed by an orthotopic kidney transplantation to the native renal artery and renal vein through a left subcostal incision. Postoperative ureteral stenosis occurred, and so stent exchange was required every 6 months. Despite the ureteral complication, the patient's serum creatinine level was 1.5 mg/dL at 2 years after the procedure.
近年来，高风险肾移植的频率有所增加。我们报告了一例病例，一名72岁男性患有多种严重合并症（前列腺癌、糖尿病、完全性房室传导阻滞、冠状动脉狭窄、腘动脉严重狭窄以及髂动脉严重钙化），接受了原位肾移植。为防止因窃血现象（由肾移植引起）导致急性肢体缺血的发生，我们认为涉及髂动脉的异位肾移植不是合适的选择。因此，作为替代方案，先进行了左肾切除术，然后通过左肋下切口将肾脏原位移植到原来的肾动脉和肾静脉。术后发生了输尿管狭窄，因此每6个月需要更换支架。尽管有输尿管并发症，但术后2年患者的血清肌酐水平为1.5mg/dL。
