Fernández Aparicio T, Miñana López B, Fraile Gómez B, Polo Villar G, Díaz González R, Leiva Galvis O
Servicio Urología, Hospital General Universitario Morales Meseguer, Murcia, España.
Arch Esp Urol. 1996 Dec;49(10):1079-91.
Renal transplantation is currently the treatment of choice for most of the cases with end-stage renal failure. However, approximately 35% present failure of graft function within 5 years post-transplantation. The need for graft removal, which is infrequently discussed in the literature, and the surgical technique employed are discussed.
From September, 1976 to December, 1994, we have performed 877 renal transplants; of these, 145 (16.5%) required removal. The literature is reviewed, with special reference to the indications for graft removal and the different surgical techniques employed.
Our data show that 42% of non-functioning renal transplants required removal at some time. No complications arising from conservative management were observed in the remaining 58%. Graft failure due to acute or early acute rejection invariably necessitated removal; thereafter transplant nephrectomy was uncommon. There were no deaths from failed grafts maintained in situ in this series.
Like other authors, our approach is to leave the graft in situ with or without low doses of corticosteroids. Transplant nephrectomy is reserved for the symptomatic cases. For cases requiring nephrectomy less than three months post-transplantation, we utilize the extracapsular approach; thereafter we utilize the subcapsular technique.
肾移植目前是大多数终末期肾衰竭病例的首选治疗方法。然而，约35%的患者在移植后5年内出现移植肾功能衰竭。本文讨论了文献中较少提及的移植肾切除的必要性以及所采用的手术技术。
1976年9月至1994年12月，我们共进行了877例肾移植手术；其中145例（16.5%）需要进行移植肾切除。本文回顾了相关文献，特别提及了移植肾切除的指征和所采用的不同手术技术。
我们的数据显示，42%的无功能移植肾在某些时候需要切除。其余58%未观察到因保守治疗引起的并发症。急性或早期急性排斥反应导致的移植肾功能衰竭总是需要切除移植肾；此后移植肾切除术并不常见。本系列中，原位保留失败移植肾的患者无死亡病例。
与其他作者一样，我们的方法是无论是否使用低剂量皮质类固醇，均将移植肾原位保留。移植肾切除术仅用于有症状的病例。对于移植后不到三个月需要肾切除的病例，我们采用包膜外入路；此后我们采用包膜下技术。
