腎移植後腎動脈狹窄的處置: 病例報告及文獻回顧
溫晨越、林仁泰、余家政、陳逸軒、陳盈伸
高雄榮民總醫院 外科部 泌尿外科
Management of Transplant Renal Artery Stenosis: Two Case Reports and Literature Review
Chen-Yueh Wen, Jen-Tai Lin, Chia-Cheng Yu, I-Hsuan Alan Chen, Yin-Shen Chen
Divisions of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
Background:
Transplant renal artery stenosis (TRAS) is one of the vascular complications after renal transplantation. Most of TRAS occur in the anastomotic region which usually happen early in transplant and related to trauma to donor or recipient vessels during surgical manipulation. It must be diagnosed and treated immediately, otherwise hypertension, deterioration in renal function, and graft loss could occur. We herein present 2 case of TRAS.
Case Presentation-Case 1:
A 63-year-old male with end-stage renal disease received a living donor kidney transplantation. We used end-to-side anastomosis method for kidney implantation. The level of creatinine increased to 6.17 mg/dL post operation day 2. Regular sonography doppler examination indicated a decreased resistance index in intrarenal arteries and increased blood flow of the transplant renal artery. Arteriography was performed and demonstrated TRAS at anastomotic region.
Case Presentation-Case 2:
A 59-year-old woman had past history of diabetes, chronic kidney disease, and cardiovascular disease. She had undergone ABO incompatible living-donor kidney transplantation and end-to-side anastomosis for end-stage renal disease secondary to diabetic nephropathy 10 years earlier. After surgery, poor urine output <0.5 ml/kg/hr was noted. Focal severe stenosis at the vascular anastomotic site was found by regular sonography doppler examination and confirmed by arteriography.
Both cases received endovascular treatment successfully with 6x18mm premount balloon expanding bare metal stent from left femoral artery approach. After treatment, kidney function was improved and urine output was also increased. There were no re-stenosis after 5 months follow-up.
Conclusion:
we described two cases of TRAS that were successfully treated via endovascular stenting treatment. It is safe and effective on graft survival and graft function.