背景:自发性移植肾破裂(KAR)是肾移植的严重并发症。当在器官取出时没有可识别的损伤存在时,KAR发生。KAR与急性排斥反应有关,肾静脉血栓形成,严重的急性肾小管坏死,或者外伤.近年来,低温机械灌注(HMP)的引入为移植肾的保存提供了一个很好的选择,降低了移植肾功能延迟的发生率.另一方面,HMP还可以代表脆弱移植物的潜在创伤性事件,特别是属于扩大标准捐赠者的。
方法:这里,根据我们的知识,我们报告了使用HMP后的第一例KAR,这种情况发生在60岁的女性中,这些女性接受了一次肾脏移植,来自脑死亡后的捐赠,属于扩展标准捐赠者类别。用具有被动氧合的HMP灌注同种异体移植物240分钟。移植后的过程与早期移植物功能无关,但是在术后第14天,患者抱怨移植部位剧烈疼痛。计算机断层扫描显示移植物周围区域有大量液体聚集。立即手术探查显示在肾脏的上极和中极处有2处10厘米和5厘米长的撕裂,需要移植切除.组织学上,移植物未显示急性排斥反应的特征.
结论:在本案例中,移植肾的修复和抢救是不可能的。然而,相关文献综述未报道另一例HMP与KAR相关的病例.
BACKGROUND: Spontaneous kidney allograft rupture (KAR) is a severe complication of kidney transplant. KAR occurs when no identifiable injuries noted at the time of the organ retrieval are present. KAR is associated with acute rejection, renal vein thrombosis, severe acute tubular necrosis, or trauma. In recent years, the introduction of hypothermic machine perfusion (HMP) has provided an excellent option for kidney allograft preservation reducing the incidence of delayed graft function. On the other hand, HMP can also represent a potentially traumatic event for a fragile graft, especially one belonging to expanded criteria donor.
METHODS: Here, to our knowledge, we report the first
case of KAR after the use of HMP, which occurred in 60-year-old women undergoing a single kidney transplant from a donation after brain death donor belonging to the expanded criteria donor category. The allograft was perfused for 240 minutes with HMP with passive oxygenation. The post-transplant course was unremarkable with early graft function, but on post operatory day 14 the patient complained of severe pain over the transplant site. A computed tomography scan showed a massive fluid collection in the perigraft region. Immediate surgical exploration showed 2 lacerations of 10 cm and 5 cm length at the upper and midpole of the kidney, requiring transplantectomy. Histologically, the graft did not show features of acute rejection.
CONCLUSIONS: In the presented
case, the repair and salvage of the kidney allograft was not possible. However, the review of the pertinent literature does not report another
case linking HMP to KAR.