Wang Qiang, Li Xiaoli, Liu Zhijia, Xu Junnan, Han Yong, Yu Tao, Chen Song, Tang Yuzhe, Liu Yubao, Li Xiang
Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China (mainland).
Department of Geriatric Cardiology, The 8TH Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland).
Ann Transplant. 2020 Feb 4;25:e918076. doi: 10.12659/AOT.918076.
BACKGROUND The aim of this study was to investigate the clinical features and treatment strategies of transplant renal artery stenosis (TRAS) with kidneys from donation after cardiac death (DCD). MATERIAL AND METHODS We collected the clinical data of donors and recipients of single-center DCD-induced TRAS from January 2015 to June 2017. RESULTS All the 8 cases of TRAS were from hypertensive cerebrovascular accident DCD-originated kidneys. The mean donor age was 53.5 (4557) years, with mean BMI 27.8 (26.432.3) kg/m², atherosclerosis index 5.8 (4.97.0), and renal atherosclerotic plaque. Clinical features of TRAS were: refractory hypertension with elevated serum creatinine >50%, and negative urine protein and occult blood. Ultrasound of transplanted kidneys showed renal blood flow index 0.49 (0.430.55). Angiography confirmed the diagnosis of renal artery trunk or secondary branch stenosis. There were 2 cases of moderate stenosis and 6 cases of severe stenosis. Six patients underwent stent implantation and 2 patients underwent balloon dilatation. Seven patients had serum creatinine recovery after interventional therapy during follow-up. The transplanted kidney of 1 patient ruptured 6 h after interventional therapy and was then resected. CONCLUSIONS The incidence of TRAS with hypertensive cerebrovascular accident DCD-originated kidneys is relatively high, which is a warning to kidney transplant physicians. Digital subtraction angiography (DSA) is the most reliable diagnostic means of TRAS and can be performed concurrently with intervention therapy. If the donor has severe atherosclerosis, plaques that are visible to the unaided eye in the renal artery trunk should be removed as completely as possible.
背景 本研究旨在探讨心脏死亡后器官捐献（DCD）肾移植受者移植肾动脉狭窄（TRAS）的临床特征及治疗策略。材料与方法 收集2015年1月至2017年6月单中心DCD所致TRAS供受者的临床资料。结果 8例TRAS均来自高血压性脑血管意外DCD供肾。供者平均年龄53.5（4557）岁，平均体重指数27.8（26.432.3）kg/m²，动脉粥样硬化指数5.8（4.97.0），合并肾动脉粥样硬化斑块。TRAS的临床特征为：顽固性高血压伴血清肌酐升高>50%，尿蛋白及潜血阴性。移植肾超声显示肾血流指数0.49（0.430.55）。血管造影确诊为肾动脉主干或二级分支狭窄。中度狭窄2例，重度狭窄6例。6例行支架植入术，2例行球囊扩张术。随访期间7例患者介入治疗后血清肌酐恢复。1例患者介入治疗后6小时移植肾破裂，随后行肾切除术。结论 高血压性脑血管意外DCD供肾TRAS发生率较高，应引起肾移植医师重视。数字减影血管造影（DSA）是TRAS最可靠的诊断方法，可与介入治疗同时进行。若供者存在严重动脉粥样硬化，应尽量彻底清除肾动脉主干肉眼可见的斑块。
