Homan W P, Cheigh J S, Kim S J, Mouradian J, Tapia L, Riggio R R, Stenzel K H, Rubin A L, Stubenbord W T
Ann Surg. 1977 Dec;186(6):700-3. doi: 10.1097/00000658-197712000-00006.
Experience with renal allograft fracture occurring in 21 of 246 transplants performed over a 29-month period is reviewed. Clinical manifestations included pain and tenderness at the graft site, fever, and falling hematocrit. The fracture occurred without exception in the course of an acute rejection episode. Diagnosis was made from two days to seven weeks following transplantation; in 13 patients (62%) diagnosis was made within two weeks of surgery. Severe damage to the kidney necessitated nephrectomy in all but two transplants. Of those not removed at initial exploration only one regained function to permit a dialysis-free existance for several months. Histologic examination of the fractured kidneys revealed the pathogenesis to be acute rejection in 13 (62%), accelerated acute rejection in four (19%), and a combination of these processes in four (19%). Conclusions from this study are that fractures of renal allografts: (1) are more frequent than commonly realized; (2) are primarily due to the swelling of acute rejection; (3) are often characterized by sudden onset of pain in the region of the graft accompanied by fever and falling hematocrit; (4) should be treated by prompt surgical intervention to control hemorrhage, to perform nephrectomy if indicated, and to evacuate the hematoma in order to reduce the possibility of secondary infection.
回顾了在29个月内进行的246例肾移植中有21例发生肾移植骨折的经验。临床表现包括移植部位疼痛和压痛、发热以及血细胞比容下降。骨折无一例外发生在急性排斥反应过程中。诊断在移植后2天至7周内作出；13例患者（62%）在手术后2周内作出诊断。除2例移植肾外，其余严重受损的肾脏均需进行肾切除术。在初次探查时未切除的那些移植肾中，只有1例恢复功能，得以在无需透析的情况下存活数月。对骨折肾脏的组织学检查显示，发病机制为急性排斥反应的有13例（62%），加速性急性排斥反应的有4例（19%），两者兼有的有4例（19%）。本研究的结论是，肾移植骨折：（1）比通常认为的更为常见；（2）主要是由于急性排斥反应的肿胀所致；（3）常表现为移植部位突然疼痛，并伴有发热和血细胞比容下降；（4）应通过及时的手术干预进行治疗，以控制出血，必要时进行肾切除术，并清除血肿，以降低继发感染的可能性。
