Analysis of the management and clinical effect of accessory renal artery in the living-related donor renal, transplantation
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摘要:
目的 探讨亲属活体肾移植供肾副肾动脉的处理及其临床疗效。 方法 回顾性分析277例亲属活体肾移植供、受者的临床资料。根据术前CT血管造影(CTA)结果选择供肾,并在术中处理供肾副肾动脉。总结供者术中情况,受者术中处理、术后并发症情况及预后情况。 结果 277例肾移植中,术前CTA检查发现83例供者存在副肾动脉,CTA判断准确率为95%。获取有副肾动脉的供肾58例,25例供肾副肾动脉经过血管修整重建吻合后,除1例与腹壁下动脉吻合者在关腹时发现吻合口血栓形成外,其余24例均吻合成功,血流充盈良好。术后均未发生出血、移植肾栓塞、输尿管坏死、尿瘘等并发症。移植受者和移植肾的1年存活率分别为94%和91%。单支肾动脉供肾与有副肾动脉供肾其受者的临床疗效比较,差异无统计学意义(P > 0.05)。 结论 选择合适供肾,经血管修整重建吻合移植肾副肾动脉,可获得良好移植效果。 Abstract:Objective To investigate the management and clinical effect of accessory renal artery in living-related donor renal transplantation. Methods Clinical data of 277 donors and recipients undergoing living-related donor renal transplantation were retrospectively analyzed. According to the results of preoperative CT angiography (CTA), the donor kidney was selected and the accessory renal artery of the renal graft was treated intraoperatively. Intraoperative status of the donors, and intraoperative management, postoperative complications, clinical prognosis of the recipients were summarized. Results Among 277 cases of renal transplantation, accessory renal arteries were detected in 83 donors by preoperative CTA examination with an accuracy rate of 95%. Fifty-eight donor kidneys with accessory renal arteries were obtained. Twenty-five donor kidneys with accessory renal arteries were reconstructed and anastomized by vascular repairing. Among them, 1 patient presented with anastomotic thrombosis during abdominal closure, whereas the other 24 cases were successfully anastomized with excellent blood flow. No complications, such as hemorrhage, renal graft embolism, ureteral necrosis and urinary fistula, occurred after renal transplantation. The 1-year survival rates of the recipients and renal grafts were 94% and 91%. The clinical efficacy did not significantly differ between the recipients with single renal artery and their counterparts with accessory renal artery (P > 0.05). Conclusions It can be obtained good clinical efficacy of renal transplantation by selecting a suitable donor kidney and reconstructing and anastomizing the accessory renal artery of the renal graft through vascular repair. -
表 1 单支肾动脉供肾与副肾动脉供肾的受者移植后不良事件比较
Table 1. Comparison of adverse events of recipients between single renal artery and accessory renal artery of donor kidney after transplantation [n(%)]
供肾动脉类型 n 不良事件 死亡 排斥反应 移植肾失功 单支肾动脉 219 10(4.6) 19(8.7) 7(3.2) 有副肾动脉 58 3(5.2) 5(8.6) 2(3.4) -
[1] TIMSIT MO, KLEINCLAUSS F, THURET R. History of kidney transplantation surgery[J]. Prog Urol, 2016, 26(15):874-881. DOI: 10.1016/j.purol.2016.08.003. [2] 中华医学会器官移植学分会, 中国医师协会器官移植医师分会.中国活体供肾移植临床指南(2016版)[J].器官移植, 2016, 7(6):417-426.DOI: 10.3969/j.issn.1674-7445.2016.06.002.Branch of Organ Transplantation of Chinese Medical Association, Branch of Organ Transplant Physician of Chinese Medical Doctor Association. Clinical guideline on living donor renal transplantation in China(2016 edition)[J]. Organ Transplant, 2016, 7(6):417-426. DOI: 10.3969/j.issn.1674-7445.2016.06.002. [3] YACOUBIAN AA, DARGHAM RA, KHAULI RB. A review of the possibility of adopting financially driven live donor kidney transplantation[J]. Int Braz J Urol, 2018, 44(6):1071-1080. DOI: 10.1590/S1677-5538.IBJU. 2017.0693. [4] MATAR AJ, FILES J, BURKHOLDER R, et al. Evaluating living donor kidney transplant rates: are you reaching your potential?[J]. Clin Transplant, 2017, 31(4). DOI: 10.1111/ctr.12914. [5] ZHAO XY, TIAN J, RU YH, et al. Application value of multislice spiral computed tomography angiography in the evaluation of renal artery variation in living donor kidney transplantation[J]. Genet Mol Res, 2015, 14(1):314-322. DOI: 10.4238/2015.January.23.5. [6] ÇIRA K, DEMIRTAŞ H, DURMAZ MS, et al. Evaluation of renal arteries of 286 living donors by multidetector computed tomography angiography: a single-center study[J]. Exp Clin Transplant, 2015, 13(6):581-587. DOI: 10.6002/ect.2015.0016. [7] TAGHIZADEH AFSHARI A, MOHAMMADI FALLAH MR, ALIZADEH M, et al. Outcome of kidney transplantation from living donors with multiple renal arteries versus single renal artery[J]. Iran J Kidney Dis, 2016, 10(2):85-90. [8] GIOVANARDI F, NUDO F, LAI Q, et al. Surgical technique notes of arterial vascular reconstruction during kidney transplantation: personal experience and literature review[J]. Transplant Proc, 2019, 51(1):128-131. DOI: 10.1016/j.transproceed.2018.04.072. [9] ZORGDRAGER M, KRIKKE C, HOFKER SH, et al. Multiple renal arteries in kidney transplantation: a systematic review and Meta-analysis[J]. Ann Transplant, 2016, 21:469-478. doi: 10.12659/AOT.898748 [10] ANTONOPOULOS IM, YAMAÇAKE KG, OLIVEIRA LM, et al. Revascularization of living-donor kidney transplant with multiple arteries: long-term outcomes using the inferior epigastric artery[J]. Urology, 2014, 84(4):955-999. DOI: 10.1016/j.urology.2014.06.022. [11] WONG C, MERKUR H. Inferior epigastric artery: surface anatomy, prevention and management of injury[J]. Aust N Z J Obstet Gynaecol, 2016, 56(2):137-141. DOI: 10.1111/ajo.12426. [12] MUSTIAN MN, HANAWAY M, KUMAR V, et al. Patient perspectives on weight management for living kidney donation[J]. J Surg Res, 2019, 244:50-56. DOI: 10.1016/j.jss.2019.06.026. [13] GO J, PARK SC, YUN SS, et al. Exposure to hyperchloremia is associated with poor early recovery of kidney graft function after living-donor kidney transplantation: a propensity score-matching analysis[J]. J Clin Med, 2019, 8(7): E955. DOI: 10.3390/jcm8070955. [14] BARNIEH L, KLARENBACH S, ARNOLD J, et al. Nonreimbursed costs incurred by living kidney donors: a case study from Ontario, Canada[J]. Transplantation, 2019, 103(6):e164-e171.DOI: 10.1097/TP.0000000000002685. [15] RODRIGUE JR, FLEISHMAN A, SOKAS CM, et al. Rates of living kidney donor follow-up: findings from the KDOC study[J]. Transplantation, 2019, 103(7):e209-e210.DOI: 10.1097/TP.0000000000002721. [16] TIETJEN A, HAYS R, MCNATT G, et al. Billing for living kidney donor care: balancing cost recovery, regulatory compliance, and minimized donor burden[J]. Curr Transplant Rep, 2019, 6(2):155-166. DOI: 10.1007/s40472-019-00239-0. [17] RODRIGUES S, ESCOLI R, EUSÉBIO C, et al. A survival analysis of living donor kidney transplant[J]. Transplant Proc, 2019, 51(5):1575-1578. DOI: 10.1016/j.transproceed.2019.01.047. [18] STEINER RW. Amending a historic paradigm for selecting living kidney donors[J]. Am J Transplant, 2019, 19(9):2405-2406.1575-1578. DOI: 10.1111/ajt.15469. [19] MORALES-BUENROSTRO LE, ORTEGA TREJO JA, PÉREZ-VILLALVA R, et al. Spironolactone reduces oxidative stress in living donor kidney transplantation: a randomized controlled trial[J]. Am J Physiol Renal Physiol, 2019, 317(3): F519-F528. DOI:10.1152/ajprenal. 00606.2018. [20] RUCKLE D, KEHEILA M, WEST B, et al. Should donors who have used marijuana be considered candidates for living kidney donation?[J]. Clin Kidney J, 2018, 12(3):437-442. DOI: 10.1093/ckj/sfy107. [21] NUNES-CARNEIRO D, MARQUES-PINTO A, VEIGA C, et al. Which one is the best for living donation: a multiple-artery left kidney nephrectomy or a right kidney nephrectomy?[J]. Transplant Proc, 2019, 51(5):1559-1562. DOI: 10.1016/j.transproceed.2019.01.045. [22] LIYANAGE L, MUZAALE A, HENDERSON M. The true risk of living kidney donation[J]. Curr Opin Organ Transplant, 2019, 24(4):424-428. DOI: 10.1097/MOT.0000000000000654.