亲属活体肾移植供肾副肾动脉的处理及临床疗效分析

潘国政; 翟凤仙; 李势辉; 戴帅; 刘洪涛

doi:10.3969/j.issn.1674-7445.2019.05.019

亲属活体肾移植供肾副肾动脉的处理及临床疗效分析

doi: 10.3969/j.issn.1674-7445.2019.05.019

230001 合肥，中国科学技术大学附属第一医院器官移植中心（潘国政、李势辉、戴帅、刘洪涛）; 安徽医科大学病理生理教研室（翟凤仙）

基金项目:

安徽省自然科学基金青年项目 1908085QH354

安徽省自然科学基金青年项目 1908085QH320

安徽省高校自然科学基金重点项目 KJ2016A356

详细信息

作者简介:
潘国政，男，1985年生，博士，主治医师，研究方向为肾移植临床与基础研究，Email:Feng123456@126.com

通讯作者:
刘洪涛，男，1966年生，博士，副主任医师，研究方向为肾移植，Email:lht1966ah@163.com

中图分类号: R617, R445.3
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- 被引次数: 0
出版历程
- 收稿日期: 2019-06-21
- 网络出版日期: 2021-01-19
- 刊出日期: 2019-09-15

Analysis of the management and clinical effect of accessory renal artery in the living-related donor renal, transplantation

Organ Transplantation Center, the First Affiliated Hospital of University of Science and Technology of China, Hefei 230001, China

More Information

Corresponding author: Liu Hongtao, Email:lht1966ah@163.com

摘要

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。
- 肾移植 /
- 活体供肾 /
- 副肾动脉 /
- 血管吻合 /
- 群体反应性抗体 /
- CT血管造影 /
- 血栓形成 /
- 移植肾失功
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.
- Renal transplantation /
- Living donor kidney /
- Accessory renal artery /
- Vascular anastomosis /
- Panel reactive antibody /
- CT angiography /
- Thrombosis /
- Renal graft failure

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图 1 术前CTA副肾动脉漏报的CT图片

A图为术前CTA提示双肾均无副肾动脉; B图为术中发现肾门处一细小副肾动脉（白色箭头所指）; C图为术后二次对照CTA发现左肾肾门该支细小副肾动脉（白色箭头所指）; D图为术后二次对照CTA发现该支细小副肾动脉（红色箭头所指）走行在左肾静脉主干后下方

Figure 1. CT pictures of accessory renal artery not reported by CTA before operation

下载: 全尺寸图片幻灯片

图 2 术前CTA副肾动脉误报的CT图片

CTA肠系膜下动脉分支向左肾下极延伸（白色箭头所指），但并未入肾

Figure 2. CT pictures of misalarm of accessory renal artery in CTA before operation

下载: 全尺寸图片幻灯片

图 3 肾移植术中副肾动脉处理情况

A图示上极副肾动脉结扎（箭头所指为缺血区域）; B图示下极副肾动脉与腹壁下动脉吻合（箭头所指为副肾动脉吻合口）

Figure 3. Management of accessory renal artery in renal transplantation

下载: 全尺寸图片幻灯片

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
供肾动脉类型	n	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）

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参考文献(22)

[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.