Columbia University Irving Medical Center, Department of Urology.
Weill Cornell Medical College, Department of Urology, New York, New York, USA.
Curr Opin Nephrol Hypertens. 2023 Mar 1;32(2):183-192. doi: 10.1097/MNH.0000000000000860. Epub 2022 Dec 6.
To understand the indications and outcomes of renal autotransplantation, and when to consider this unique procedure for patients.
Renal autotransplantation confers acceptably low rates of graft failure and prevents need for long-term dialysis. Renal autotransplantation remains an important management strategy in very select patients for complex renovascular disease, ureteral stricture disease, ureteral trauma, upper urinary tract urothelial carcinoma, renal cell carcinoma, and Loin-Pain Hematuria Syndrome. With advancements in minimally invasive procedures, the application of renal autotransplantation for refractory stone disease is rare but exists. Robot-assisted laparoscopic renal autotransplantation demonstrates reproducible graft success and complication rates with improved perioperative outcomes (ex. hospital length of stay) - though comparative studies are lacking. Patients would benefit from a multidisciplinary approach from renal transplant surgeons, vascular surgeons, urologists, nephrologists, dieticians, pain management providers, social workers, and psychiatrists.
In experienced hands, renal autotransplantation is a reasonable treatment approach for complex and refractory renal vascular disease, Loin-Pain Hematuria Syndrome, ureteral strictures and trauma, upper urinary tract malignancy, and stone disease in highly select patients.
了解肾自体移植的适应证和结果，以及何时应考虑为患者采用这种独特的手术。
肾自体移植可接受地降低移植物失功率，并可预防长期透析的需要。对于复杂的肾血管疾病、输尿管狭窄疾病、输尿管创伤、上尿路尿路上皮癌、肾细胞癌和腰痛血尿综合征等非常特定的患者，肾自体移植仍然是一种重要的管理策略。随着微创技术的进步，肾自体移植在难治性结石病中的应用虽罕见但仍存在。机器人辅助腹腔镜肾自体移植具有可重复的移植物成功和并发症发生率，改善了围手术期结果（如住院时间）-尽管缺乏比较研究。患者将受益于多学科方法，包括肾移植外科医生、血管外科医生、泌尿科医生、肾脏病学家、营养师、疼痛管理提供者、社会工作者和精神科医生。
在有经验的手中，肾自体移植是治疗复杂和难治性肾血管疾病、腰痛血尿综合征、输尿管狭窄和创伤、上尿路恶性肿瘤以及高度选择患者的结石病的合理治疗方法。
