Treatment and effect of donor kidney with single calculus in living renal transplantation
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摘要:
目的 探讨活体肾移植中有单发结石的供肾的处理方法及疗效。 方法 总结3例术前发现单侧肾结石的活体肾移植供肾的处理经验。切取该侧肾脏作为供肾,并在体外行输尿管镜完整取石,之后按常规术式行肾移植术。 结果 3例受体术后均未出现移植物功能延迟恢复、急性排斥反应等早期并发症。3对供、受体分别随访34、45、62个月,行移植肾泌尿系统的彩色多普勒超声检查,供体保存肾及受体移植肾均未见新发结石及尿路梗阻表现。所有供、受体肾功能良好。3例供体随访至今,未发现尿常规异常。其中1例受体术后发生IgA肾病,考虑为肾病复发,与结石无关。 结论 对于活体肾移植术中的单发结石,采用供肾切取后体外输尿管镜取石是处理供肾结石的有效方法。 Abstract:Objective To explore treatment methods of donor kidney with single calculus in living renal transplantation and their effect. Methods The treatment experience of donor kidneys with unilateral renal calculus in living renal transplantation of 3 cases was summarized, which were diagnosed before operation. The kidney with renal calculus was excised as the donor kidney; ureteroscopic lithotomy was conducted in vitro, and then renal transplantation was performed by routine operation. Results There was no early complication such as delayed graft function and acute rejection in 3 recipients after operation. Three pairs of donors and recipients were followed up for 34, 45 and 62 months respectively. The color Doppler ultrasound examination of urinary system after renal transplantation showed that, new renal calculus and urinary tract obstruction did not occur in donor's preserved kidneys and recipient's transplant kidneys. Renal function of all donors and recipients was good. Three donors were followed up until now, and no abnormal urine routine was discovered. One recipient developed IgA nephropathy, which was considered to be recurrent nephropathy and had nothing to do with renal calculus. Conclusions The donor kidney with single calculus in living renal transplantation can be treated effectively by ureteroscopic lithotomy in vitro after donor kidneys are excised. -
图 1 移植肾输尿管镜取石的手术过程
注：A图为经输尿管镜取石；B图为取出完整结石1粒，直径约0.8 cm
Figure 1. Operation process of ureteroscopic nephrolithotomy for transplant kidney
表 1 3例供体的一般资料和围手术期情况
Table 1. General information and perioperative condition of 3 donors
项 目 供体1 供体2 供体3 性别 女 女 男 年龄(岁) 25 38 36 结石所在肾脏 右 右 右 结石个数 1 1 1 结石位置 肾下极 肾盂 肾下极 结石最大直径(cm) 0.5 0.8 0.3 术前Scr(μmol/L) 65 53 66 术前供肾GFR(ml/min) 50 57 45 术前保留肾GFR(ml/min) 49 53 67 注：Scr为血清肌酐，GFR为肾小球滤过率 
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表 2 3例受体的一般资料和围手术期情况
Table 2. General information and peroperative condition of 3 recipients
项 目 受体1 受体2 受体3 性别 男 男 男 年龄(岁) 34 45 35 原发病 慢性肾小球肾炎 多囊肾 慢性肾小球肾炎 热缺血时间(s) 65 60 70 冷缺血时间(min) 68 72 70
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[1] Spasovski G, Beck BB, Blau N, et al. Late diagnosis of primary hyperoxaluria after failed kidney transplantation[J]. Int Urol Nephrol,2010,42(3):825-829. doi: 10.1007/s11255-009-9690-2 [2] Trivedi A, Patel S, Devra A, et al. Management of calculi in a donor kidney[J]. Transplant Proc,2007,39(3):761-762. doi: 10.1016/j.transproceed.2007.01.059 [3] Rezaee-Zavareh MS, Ajudani R, Ramezani BM, et al. Kidney allograft stone after kidney transplantation and its association with graft survival[J]. Int J Organ Transplant Med,2015,6(3):114-118. http://cn.bing.com/academic/profile?id=2161541203&encoded=0&v=paper_preview&mkt=zh-cn [4] Janczak D, Bolanowska B, Jankowski P, et al. Ex vivo pyelotomy, nephroscopy and holmium laser lithotripsy of a staghorn stone in a donor kidney prior to renal transplant[J]. Wideochir Inne Tech Maloinwazyjne,2015,10(2):286-289. http://cn.bing.com/academic/profile?id=2409011663&encoded=0&v=paper_preview&mkt=zh-cn [5] Yuan HJ, Yang DD, Cui YS, et al. Minimally invasive treatment of renal transplant nephrolithiasis[J]. World J Urol,2015,33(12):2079-2085. doi: 10.1007/s00345-015-1549-9 [6] Wong KA, Olsburgh J. Management of stones in renal transplant[J]. Curr Opin Urol,2013,23(2):175-179. doi: 10.1097/MOU.0b013e32835d3097 [7] Vasdev N, Moir J, Dosani MT, et al. Endourological management of urolithiasis in donor kidneys prior to renal transplant[J]. ISRN Urol,2011:242690. http://cn.bing.com/academic/profile?id=2002526255&encoded=0&v=paper_preview&mkt=zh-cn [8] Krambeck AE, Leroy AJ, Patterson DE, et al. Percutaneous nephrolithotomy success in the transplant kidney[J]. J Urol,2008,180(6):2545-2549. doi: 10.1016/j.juro.2008.08.032 [9] Beckly J, Bhandari S, Eris J, et al. The man who gained a stone[J]. Nephrol Dial Transplant,2003,18(2):434-435. doi: 10.1093/ndt/18.2.434 [10] Rashid MG, Konnak JW, Wolf JJ, et al. Ex vivo ureteroscopic treatment of calculi in donor kidneys at renal transplantation[J]. J Urol,2004,171(1):58-60. doi: 10.1097/01.ju.0000101757.69344.de [11] Pham PC, Wilkinson AH, Pham PT. Evaluation of the potential living kidney donor[J]. Am J Kidney Dis,2007,50(6):1043-1051. doi: 10.1053/j.ajkd.2007.08.022 [12] Rizkala E, Coleman S, Tran C, et al. Stone disease in living-related renal donors: long-term outcomes for transplant donors and recipients[J]. J Endourol,2013,27(12):1520-1524. doi: 10.1089/end.2013.0203 [13] Devasia A, Chacko N, Gnanaraj L, et al. Stone-bearing live-donor kidneys for transplantation[J]. BJU Int,2005,95(3):394-397. doi: 10.1111/bju.2005.95.issue-3 [14] Benoit G, Blanchet P, Eschwege P, et al. Occurrence and treatment of kidney graft lithiasis in a series of 1500 patients[J]. Clin Transplant,1996,10(2):176-180. http://cn.bing.com/academic/profile?id=2413123087&encoded=0&v=paper_preview&mkt=zh-cn [15] Martin G, Sundaram CP, Sharfuddin A, et al. Asymptomatic urolithiasis in living donor transplant kidneys: initial results[J]. Urology,2007,70(1):2-5, 5-6. doi: 10.1016/j.urology.2007.01.105 [16] Lim JH, Cho JH, Lee JH, et al. Risk factors for recurrent urinary tract infection in kidney transplant recipients[J]. Transplant Proc,2013,45(4):1584-1589. doi: 10.1016/j.transproceed.2012.12.011 [17] Di Carlo HN, Darras FS. Urologic considerations and complications in kidney transplant recipients[J]. Adv Chronic Kidney Dis,2015,22(4):306-311. doi: 10.1053/j.ackd.2015.04.003 [18] 赵亮,袁小鹏,王长希,等. 离体供肾结石输尿管镜下钬激光碎石术[J/CD].中华腔镜泌尿外科杂志(电子版),2013,7(1):59-60. http://www.cqvip.com/qk/88771X/201301/Zhao L, Yuan XP, Wang CX, et al. Holmium laser lithotripsy under ureter mirror for kidney stones in vitro[J/CD]. Chin J Endourol(Elect Vers),2013,7(1):59-60. http://www.cqvip.com/qk/88771X/201301/ -
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