Türkmen A, Yildiz A, Erkoç R, Ecder T, Görçin B, Türk S, Aydin A E, Eldegez U, Ark E, Sever M S
Istanbul School of Medicine, Department of Nephrology, Turkey.
Clin Transplant. 1998 Oct;12(5):375-8.
In this report, the results of renal transplantation in patients with renal amyloidosis were retrospectively analysed and compared with the control group. Fifteen (3.04%) of the 493 renal transplant recipients whom were followed up in Istanbul School of Medicine transplant outpatient clinic, between 1983 and 1997, were included in the study. The etiology of amyloidosis was familial Mediterranean fever in all patients. The mean follow-up period was 38.3 +/- 31.8 (range 7-65) months. Twelve of the patients were male and 3 female with the mean age 34.13 +/- 10.87 (range 21-60) years. Seven patients had living related, 4 living-unrelated and 4 cadaveric donors. Five patients were lost because of different complications: Three patients died from cardiac amyloidosis all with well functioning grafts, 2, 3 and 36 months after the operation. Sepsis and cardiovascular failure was the probable cause of death in 1 patient who also had chronic rejection. Another one patient with chronic rejection died from hepatic failure. Acute rejection developed in 2 patients. Renal functions of these patients improved by anti-rejection therapies. Chronic rejection developed in 3 patients. In the control group, acute rejection and chronic rejection were diagnosed in 5 and 1 patients, retrospectively. While 1 patients returned to hemodialysis in control group, the others are alive with satisfactory graft function. There was no death in control group. The 5-yr graft and patient survival rates in amyloidosis and the control groups were 75, 77, 95 and 100%, respectively. It was concluded that although transplantation is not a contraindication for the treatment of end stage renal failure in patients with renal amyloidosis, it carries high risk of cardiac complications in the postoperative period. Detailed preoperative cardiovascular evaluations are mandatory in these patients and this intervention should improve the prognosis by excluding the patients who have already been complicated with this problem.
在本报告中，对肾淀粉样变性患者肾移植的结果进行了回顾性分析，并与对照组进行了比较。1983年至1997年间在伊斯坦布尔医学院移植门诊接受随访的493例肾移植受者中，有15例（3.04%）纳入本研究。所有患者淀粉样变性的病因均为家族性地中海热。平均随访期为38.3±31.8（范围7 - 65）个月。患者中12例为男性，3例为女性，平均年龄34.13±10.87（范围21 - 60）岁。7例患者的供体为活体亲属，4例为活体非亲属，4例为尸体供体。5例患者因不同并发症失访：3例患者死于心脏淀粉样变性，移植肾均功能良好，分别在术后2个月、3个月和36个月死亡。1例同时合并慢性排斥反应的患者死于败血症和心血管衰竭，可能是死亡原因。另1例合并慢性排斥反应的患者死于肝功能衰竭。2例患者发生急性排斥反应。这些患者的肾功能通过抗排斥治疗得到改善。3例患者发生慢性排斥反应。对照组中，回顾性诊断出5例急性排斥反应和1例慢性排斥反应。对照组中有1例患者恢复血液透析，其他患者移植肾功能良好存活。对照组无死亡病例。淀粉样变性组和对照组的5年移植肾存活率和患者存活率分别为75%、77%、95%和100%。得出的结论是，虽然移植并非肾淀粉样变性患者终末期肾衰竭治疗的禁忌证，但术后心脏并发症风险较高。对这些患者进行详细的术前心血管评估是必要的，这种干预措施应通过排除已合并该问题的患者来改善预后。
