迭代式肾移植：我们在第三次移植中的经验。

Iterative renal transplantation: our experience on third transplants.

作者信息

Santos-Pérez de la Blanca Rocío, Medina-Polo José, Peña-Vallejo Elena, Pamplona-Casamayor Manuel, Teigell-Tobar Julio, Hernández-Arroyo Mario, Duarte-Ojeda José Manuel, Tejido-Sánchez Ángel, Cabrera-Meiras Fernando, Miranda-Utrera Natalia, García-González Lucía, González-Monte Esther, Rodríguez-Antolín Alfredo

机构信息

Department of Urology, University Hospital, 12 de Octubre, Av. de Córdoba s/n, 28041, Madrid, Spain.

Department of Nephrology, University Hospital, 12 de Octubre, Madrid, Spain.

出版信息

Int Urol Nephrol. 2021 Jun;53(6):1097-1104. doi: 10.1007/s11255-021-02788-9. Epub 2021 Mar 6.

DOI:10.1007/s11255-021-02788-9

PMID:33675472

Abstract

PURPOSE

To report our experience on third kidney transplantation, analyzing the complications and graft survival rates as compared to previous transplants.

METHODS

Retrospective study of third renal transplants performed at our center. Outcomes were compared with a cohort of first and second transplants.

RESULTS

Of a total of 4143, we performed 72 third transplants in 46 men and 26 women with an average age of 46 years and mean time on dialysis of 70 months. Thirty-seven patients were hypersensitized [panel-reactive antibody (PRA) > 50%]. They were all from deceased donors, with a mean cold ischemia time of 19.2 h. The extraperitoneal heterotopic approach was used in 88.8%, transplantectomy was performed in 80.6% and vascular anastomoses were realized mostly to external iliac vessels, using the common iliac artery in 15 cases, and the inferior vena cava in 16. The main ureteral reimplantation technique was the Politano-Leadbetter (76.4%). Third transplantation reported a significantly higher incidence of lymphocele (13.9% vs. 3.2% in first and 4.5% in second transplants; p < 0.001), rejection (34.7% vs. 14.9% and 20.5%, p < 0.001) and urinary obstruction (11.1% vs. 3.6% and 6.3%, p 0.002). Graft survival rates for first, second and third transplants were 87%, 86% and 78% at 1 year, 83%, 82% and 74% at 3 years and 80%, 79% and 65% at 5 years, respectively.

CONCLUSION

Iterative transplantation constitutes a valid therapeutic option with adequate surgical and survival results compared to previous transplants. It is a challenging procedure which must be performed by experienced surgeons.

摘要

目的

报告我们在第三次肾移植方面的经验，分析与以往移植相比的并发症和移植物存活率。

方法

对我们中心进行的第三次肾移植进行回顾性研究。将结果与首次和第二次移植队列进行比较。

结果

在总共4143例中，我们对46名男性和26名女性进行了72次第三次移植，平均年龄46岁，平均透析时间70个月。37例患者高度致敏[群体反应性抗体（PRA）>50%]。他们均来自已故供体，平均冷缺血时间为19.2小时。88.8%采用腹膜外异位途径，80.6%进行了移植肾切除术，血管吻合大多在髂外血管进行，15例使用髂总动脉，16例使用下腔静脉。主要的输尿管再植技术是波利塔诺-利德贝特法（76.4%）。第三次移植报告淋巴囊肿发生率显著更高（分别为13.9%，首次移植为3.2%，第二次移植为4.5%；p<0.001）、排斥反应（分别为34.7%、14.9%和20.5%，p<0.001）和尿路梗阻（分别为11.1%、3.6%和6.3%，p=0.002）。首次、第二次和第三次移植移植物1年存活率分别为87%、86%和78%，3年存活率分别为83%、82%和74%，5年存活率分别为80%、79%和65%。