Bañuelos Marco Beatriz, Bergel Berenice, Geppert Tamara, Müller Dominik, Lingnau Anja
Department Paediatric Urology, Charité Universitätsmedizin Berlin, Berlin, Germany.
Charité Universitätsmedizin Berlin, Berlin, Germany.
Front Surg. 2022 May 6;9:840055. doi: 10.3389/fsurg.2022.840055. eCollection 2022.
Renal allograft compartment syndrome (RACS) is a complication that infrequently occurs after renal transplantation. Tight muscle closure may lead to RACS due to compression of renal parenchyma or kinking of the renal vessels. Many techniques have been proposed in an attempt to achieve tension-free closure, which can be specially challenging in child recipients. We present our experience with Tutoplast Fascia Lata (RTI Surgical Tutogen Medical GmbH Industriestrasse 6, 91077 Neunkirchen am Brand, Germany) closure.
All pediatric patients who underwent renal transplantation in our center between 2012 and 2021 were reviewed. Eight patients with Tutoplast Fascia Lata placed at the time of initial transplantation were identified. Donor and recipient characteristics, Doppler ultrasound findings, and overall patient and graft survival rates were analyzed.
Doppler ultrasound was performed intra-operatively after abdominal wall closure. If any sign of vascular compromise was seen, the abdominal wall was opened and the graft was revised. The Tutoplast Fascia Lata implant was used to perform tension-free fascia closure and, afterwards, a Doppler ultrasound was performed to confirm the optimal renal artery perfusion and venous patency. Three of the renal transplantations were from a cadaver donor, with two of them en bloc. Living donor transplantation was performed in four cases. Among which, there was a case of auto-transplantation due to bilateral renal artery stenosis. None of the patients presented any complications of either short or long term that was derived from the abdominal closure with Tutoplast Fascia Lata. There was also no record of graft failure till datum.
Restricted volume of the recipient pelvic cavity and the size discrepancy between the recipient pelvic cavity space and the donor adult kidney may lead to RACS. Other situations that occur more infrequently, i.e., as en bloc or auto-transplantation, are prone to suffer the same problem. Tutoplast Fascia Lata is a safe option for these patients.
肾移植后极少发生的一种并发症是同种异体肾移植隔室综合征（RACS）。由于肾实质受压或肾血管扭结，肌肉紧密缝合可能导致RACS。人们提出了许多技术来实现无张力缝合，这对儿童受者来说可能特别具有挑战性。我们介绍了使用Tutoplast阔筋膜（德国新基兴市工业大街6号，RTI Surgical Tutogen Medical GmbH，91077）缝合的经验。
回顾了2012年至2021年期间在我们中心接受肾移植的所有儿科患者。确定了8例在初次移植时使用Tutoplast阔筋膜的患者。分析了供体和受体特征、多普勒超声检查结果以及患者和移植物的总体存活率。
腹壁关闭后在术中进行多普勒超声检查。如果发现任何血管受损迹象，打开腹壁并对移植物进行检查。使用Tutoplast阔筋膜植入物进行无张力筋膜缝合，然后进行多普勒超声检查以确认肾动脉灌注最佳和静脉通畅。其中3例肾移植来自尸体供体，其中2例为整块移植。4例为活体供体移植。其中1例因双侧肾动脉狭窄进行了自体移植。所有患者均未出现因使用Tutoplast阔筋膜进行腹壁缝合而导致的短期或长期并发症。截至目前也没有移植物失败的记录。
受者盆腔容积受限以及受者盆腔空间与供体成人肾脏之间的大小差异可能导致RACS。其他较少见的情况，如整块移植或自体移植，也容易出现同样的问题。Tutoplast阔筋膜对这些患者来说是一种安全的选择。
