Memel D S, Dodd G D, Shah A N, Zajko A B, Jordan M L, Shapiro R, Hakala T R
Department of Radiology, University of Pittsburg Medical Center, Presbyterian University Hospital, PA 15213.
AJR Am J Roentgenol. 1993 Jan;160(1):75-81. doi: 10.2214/ajr.160.1.8416653.
Cadaveric kidneys from donors less than 5 years old, previously considered inferior graft material, are now being successfully transplanted en bloc into children and adults. On the basis of our experience with 132 patients, we describe the general principles of the procedure and review the spectrum of normal and abnormal imaging findings in patients who have undergone this promising transplantation procedure.
Paired cadaveric kidneys obtained from donors less than 5 years old (mean age, 24 months) were transplanted en bloc to 132 patients (mean age, 37 years) at our institution between 1981 and 1991. All available medical, surgical, pathologic, and imaging records were retrospectively reviewed to define the surgical technique, 1-year survival rate of the graft, appearance of the transplant on postoperative imaging studies, and the prevalence of and imaging findings caused by vascular, urinary, infectious, and neoplastic complications after transplantation. Complications were confirmed by a definitive imaging study, surgical exploration, or study of a pathologic specimen.
Paired donor kidneys were transplanted en bloc extraperitoneally into the recipient's right or left iliac fossa, with intact portions of the donor aorta and inferior vena cava anastomosed to the recipient's external iliac artery and vein. One-year graft survival was 70% during the first 8 years of the study and 78% during the last 2 years. Postoperative imaging, particularly sonography and scintigraphy, clearly depicted the normal individual kidneys, urinary collecting systems, and en bloc vasculature. Postoperative complications were vascular (arterial stenoses and thromboses, venous thromboses, and pseudoaneurysms) in 18%, urinary (obstruction and anastomotic leak) in 11%, infectious (caliceal fungal balls) in 1%, and neoplastic (posttransplant lymphoma) in 1%. The complications involved one kidney in 60% of the patients and both kidneys in 40%. The imaging findings caused by these complications were similar to those caused by complications occurring after transplantation of single cadaveric kidneys; however, their detection was more difficult because of the complexity of the en bloc graft.
Because of the shortage of available donor organs, en bloc renal transplantation will most likely become increasingly popular. Familiarity with the imaging appearance of the normal transplant and of posttransplantation complications will allow radiologists to perform effective postoperative imaging evaluations.
来自5岁以下供体的尸体肾，以前被认为是质量较差的移植材料，现在已成功地整块移植到儿童和成人体内。基于我们对132例患者的经验，我们描述了该手术的一般原则，并回顾了接受这种有前景的移植手术患者的正常和异常影像表现范围。
1981年至1991年间，我们机构将从5岁以下供体（平均年龄24个月）获取的成对尸体肾整块移植给132例患者（平均年龄37岁）。回顾所有可用的医学、外科、病理和影像记录，以确定手术技术、移植肾1年生存率、术后影像检查中移植肾的表现，以及移植后血管、泌尿、感染和肿瘤并发症的发生率及影像表现。并发症通过确定性影像检查、手术探查或病理标本研究得以证实。
成对供体肾整块经腹膜外移植到受者的右或左髂窝，供体主动脉和下腔静脉的完整部分与受者的髂外动脉和静脉吻合。在研究的前8年，移植肾1年生存率为70%，后2年为78%。术后影像检查，尤其是超声和闪烁扫描，清晰显示了单个正常肾、泌尿收集系统和整块血管。术后并发症包括血管性（动脉狭窄和血栓形成、静脉血栓形成和假性动脉瘤）18%、泌尿性（梗阻和吻合口漏）11%、感染性（肾盏真菌球）1%和肿瘤性（移植后淋巴瘤）1%。60%的患者并发症累及一个肾，40%累及两个肾。这些并发症引起的影像表现与单个尸体肾移植后并发症引起的表现相似；然而，由于整块移植的复杂性，其检测更为困难。
由于可用供体器官短缺，整块肾移植很可能会越来越普遍。熟悉正常移植肾的影像表现和移植后并发症将使放射科医生能够进行有效的术后影像评估。
