实用器官移植电子杂志

实用器官移植电子杂志 ›› 2021, Vol. 9 ›› Issue (2): 105-109.DOI: 10.3969/j.issn.2095-5332.2021.02.005

• 论著 • 上一篇    下一篇

357 例儿童死亡后器官捐献供肾移植血栓性并发症回顾性分析

胡善彪，代贺龙，余少杰，郭勇，蓝恭斌，彭风华，谢续标，彭龙开
  

  1. 中南大学湘雅二医院肾脏移植科，湖南 长沙 410011
  • 出版日期:2021-03-20 发布日期:2021-05-28

Thrombotic complications of kidney transplantation from deceased pediatric donors: a retrospective study of357 cases

Hu Shanbiao，Dai Helong，Yu Shaojie，Guo Yong，Lan Gongbin，Peng Fenghua，Xie Xubiao，Peng Longkai.
  

  1. Department ofkidney transplantation, the Second Xiangya Hospital of Central South University，Changsha 410011， Hunan，China.
  • Online:2021-03-20 Published:2021-05-28

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摘要：

目的 回顾性分析本中心儿童死亡后器官捐献（deceased donor，DD）供肾移植血栓性并发症的发生率以及相关影响因素。方法 收集中南大学湘雅二医院 2012 年 1 月— 2018 年 12 月完成的 357 例儿童 DD 供肾移植相关资料，将其分为三组，将 297 例单肾移植设为组一，60 例双肾移植中，32 例供体满足三“5”原则（供体年龄＞ 5 个月，供体体重＞ 5 kg，供肾长径＞ 5 cm）设为组二，28 例不满足三“5”原则者设为组三，统计血栓性并发症的发生率，分析供体年龄、供肾大小以及手术方式的选择与术后血栓性并发症的关系。结果 组一 297 例单肾移植受体有 2 例发生移植肾栓塞，发生率为 0.67%，经分析为外科操作失误所致 ；组二 32 例双肾移植受体未出现血栓并发症，1 例出现肾动脉狭窄 ；组三中有 5 例受体发生移植肾栓塞，其中 3 例单肾动脉栓塞，1 例双肾动脉栓塞，1 例单肾静脉栓塞，其均为采用分离式双肾移植术式的受体，栓塞发生率为 17.8%，而接受“利用主动脉远端建立流出道的双肾移植”术式的 18 例受体无 1 例发生栓塞。结论 儿童供肾移植术后血栓并发症与供体年龄，供肾大小及外科技术有关。供体年龄＜ 5 个月，供体体重＜ 5 kg，供肾长径＜ 5 cm 的供体栓塞发生率明显升高。“利用主动脉远端建立流出道的双肾整块移植”术后栓塞发生率低，可有效解决婴幼儿供肾移植栓塞难题，但仍需扩大样本量以及长期随访。

关键词: 肾移植 , 栓塞 , 并发症 , 儿童供肾

Abstract:

Objective To retrospectively analyze the incidence of thrombotic complications of kidney transplantation from deceased pediatric donors and the related influencing factors in the Second XiangyaHospital. Methods A retrospective analysis of 357 cases of kidney transplantation from deceased pediatric donors in our hospital between January 2012 and December, 2018  was performed. The cases are divided into threegroups as following: 297 cases of single kidney transplant as group 1, 32 cases of double kidney transplant recipientswho meet the three "5" principles（donor age ＞ 5 month, donor weight ＞ 5 kg, renal length ＞ 5 cm）as group 2,  

a total number of 28 cases of double kidney transplant recipients who did not meet the three "5" principle as group 3. Then the relationship between the incidence of thrombotic complications and donor age, donor renal size and theoperation methods were analyzed. Results In the group of 297 single renal transplant recipients, 2 cases hadthrombotic complications; the incidence was 0.67%, which was caused by surgical error. There were no thromboticcomplications for 32 recipients of double kidney transplantation in the group 2, however, one patient developedrenal artery stenosis. Five cases had renal embolization in those using separate double kidney transplant operationin group 3, includng 3 cases of single renal artery embolism, 1 case of bilateral renal artery embolization and 1 case of single renal vein embolism. The incidence was 17.8% in group 3. However, 18 cases of recipients who receiving“en bloc kidney transplantation（EBKT）using the distal abdominal aorta as an outflow tract "had no embolismevents. Conclusion The incidence of thrombotic complications of kidney transplantation from deceased pediatric donors is related to donor age, donor kidney size and surgical technique. Donor age ＜ 5 months, donor weight ＜ 5 kg and donor kidney length ＜ 5 cm, the incidence of embolism was significantly increased.“EBKT using the distalabdominal aorta as an outflow tract”had a low incidence of embolism，seemed to be an effective method to solve theproblem of high incidence of embolism in kidney transplantation from neonatal donors, but expanded samples size andlong-term follow-up are still needed.

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