Nédélec M, Glémain P, Rigaud J, Karam G, Thuret R, Badet L, Kleinclauss F, Timsit M O, Branchereau J
Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, 44093 Nantes, France.
Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, 44093 Nantes, France; Comité de transplantation et d'insuffisance rénale chronique (CTIRC), 75017 Paris, France.
Prog Urol. 2019 Oct;29(12):603-611. doi: 10.1016/j.purol.2019.06.005. Epub 2019 Aug 22.
In front of a very calcified aortoiliac axis, renal transplantation with implantation of the artery on vascular prosthesis can be proposed. This rare intervention is considered difficult and morbid. The main objective of this work was to evaluate the overall and specific survival of the transplant in this situation. The secondary objective was the study of the complications and the evolution of the transplant's renal function.
From a multicenter retrospective data collection of the DIVAT cohort (6 centers) added with data from 4 other transplant centers, we studied transplants with prosthetic arterial anastomosis.
Thirty four patients was included. The median duration of follow-up was 2.5 years. 4 patients died in the month following transplantation, 16 were hemodialysis and 9 were transfused. The median survival of the transplant was 212 days. Functional arrests of the transplant were mostly associated with nephrological degradation and return to dialysis (about 80%) while 10% were related to a death of the recipient directly attributable to renal transplantation. The surgical complications of the transplantation were marked by one arterial stenosis, one fistula and 4 urinary stenoses.
Thus, renal transplantation with arterial anastomosis on vascular prosthesis, on selected patients, offers an alternative to dialysis. A national compendium of transplanted patients on vascular prosthesis would allow a long-term follow-up of transplant's survival and define selection criteria prior to this kind of surgery.
在严重钙化的主-髂动脉轴面前，可以考虑进行肾移植并将动脉植入血管假体。这种罕见的干预措施被认为难度大且具有高风险性。这项研究的主要目的是评估这种情况下移植肾的总体和特定生存率。次要目的是研究并发症以及移植肾功能的演变情况。
通过对DIVAT队列（6个中心）进行多中心回顾性数据收集，并补充来自其他4个移植中心的数据，我们研究了采用人工血管动脉吻合术的肾移植病例。
共纳入34例患者。中位随访时间为2.5年。4例患者在移植后1个月内死亡，16例接受血液透析，9例接受输血治疗。移植肾的中位生存期为212天。移植肾功能丧失主要与肾脏功能恶化及重新开始透析有关（约80%），而10%与受者直接因肾移植死亡有关。移植手术的并发症表现为1例动脉狭窄、1例瘘管和4例尿路狭窄。
因此，对于选定的患者，采用血管假体进行动脉吻合的肾移植为透析提供了一种替代方案。建立全国性的血管假体移植患者名录将有助于对移植肾的长期生存情况进行随访，并在此类手术前确定选择标准。
3级。
