Panneton J M, Gloviczki P, Canton L G, Bower T C, Chow M S, Pairolero P C, Schaff H V, Hallett J W, Cherry K J
Division of Vascular Surgery, Mayo Clinic, Rochester, Minn 55905, USA.
Ann Vasc Surg. 1996 Mar;10(2):97-108. doi: 10.1007/BF02000752.
Renal transplantation has increased the longevity of patients with uremia. An increasing number undergo aortic reconstruction, which exposes the transplanted kidney to ischemic injury. To evaluate the risk for renal failure, loss of the transplant, and methods of renal protection, we reviewed our experience. Clinical data were reviewed for 10 consecutive patients (7 men, 3 women; mean age 52.7 years [range 32 to 75 years]) with a transplanted kidney who underwent aortic reconstruction between 1977 and 1994 at our institution. Mean interval between renal transplantation and aortic reconstruction was 5.9 years (range 1 month to 12.7 years). Seven patients required emergency repair because of dissection (2 patients), aneurysm rupture (4 patients), or symptomatic aneurysm (1 patient); three underwent elective repair. Reasons for reconstruction included aortic dissection (2 patients), aneurysm of the descending thoracic (2 patients), thoracoabdominal (1 patient), or abdominal aorta (3 patients), and aortoiliac occlusive disease (2 patients). Patients with thoracic or thoracoabdominal reconstructions underwent repair with atriofemoral, aortofemoral, or femorofemoral shunt placement or bypass. Of the five abdominal aortic reconstructions, the kidney was protected with aortofemoral shunt placement in one patient and cold renal perfusion in three. In two of them, topical cooling of the kidney also was used. One patient with acute aortic dissection died at 39 days as a result of respiratory failure. Loss of the recently transplanted kidney was caused by acute rejection. One patient had a transient increase in serum creatinine concentration. Eight no worsening of renal function, and none of the nine survivors lost the transplanted kidney. We concluded that aortic reconstruction can be safely performed in kidney transplant recipients. Patients in whom thoracic or thoracoabdominal aortic reconstruction was required were protected with an atriofemoral or aortofemoral bypass or shunt. Patients undergoing abdominal aortic reconstruction did well when cold renal perfusion with or without local cooling of the transplant was used for renal protection. Transplanted kidneys appeared to tolerate ischemic injury similarly to native kidneys.
肾移植提高了尿毒症患者的寿命。越来越多的患者接受主动脉重建手术，这使移植肾面临缺血性损伤。为评估肾衰竭风险、移植肾丢失情况及肾脏保护方法，我们回顾了自身经验。对1977年至1994年间在我院接受主动脉重建手术的10例连续肾移植患者（7例男性，3例女性；平均年龄52.7岁[范围32至75岁]）的临床资料进行了回顾。肾移植与主动脉重建的平均间隔时间为5.9年（范围1个月至12.7年）。7例患者因夹层（2例）、动脉瘤破裂（4例）或有症状的动脉瘤（1例）需要紧急修复；3例接受择期修复。重建原因包括主动脉夹层（2例）、降主动脉（2例）、胸腹主动脉（1例）或腹主动脉（3例）动脉瘤以及主髂动脉闭塞性疾病（2例）。接受胸段或胸腹段重建的患者采用心房股动脉、主动脉股动脉或股股分流术或旁路手术进行修复。在5例腹主动脉重建中，1例患者通过主动脉股动脉分流术保护肾脏，3例通过冷肾灌注保护。其中2例还采用了肾脏局部降温。1例急性主动脉夹层患者因呼吸衰竭于39天死亡。近期移植肾丢失是由急性排斥反应所致。1例患者血清肌酐浓度短暂升高。8例患者肾功能无恶化，9例幸存者中无一例移植肾丢失。我们得出结论，肾移植受者可安全地进行主动脉重建手术。需要进行胸段或胸腹段主动脉重建的患者通过心房股动脉或主动脉股动脉旁路或分流术得到保护。接受腹主动脉重建的患者在使用冷肾灌注（无论是否对移植肾进行局部降温）进行肾脏保护时情况良好。移植肾似乎与天然肾一样能耐受缺血性损伤。
