Surgical prevention and management of vascular complications of kidney transplantation
Surgical prevention and management of vascular complications of kidney transplantation
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DOI：
10.1111/j.1432-2277.2012.01533.x
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发表时间：
2012-09-01
影响因子：
3.1
通讯作者：
Benoit, Gerard
中科院分区：
文献类型：
--
作者：
Bessede, Thomas;Droupy, Stephane;Benoit, Gerard
肾脏获取、准备和移植过程中的主要外科变化发生在20年前，尽管无法设计随机研究，但仍进行了这些变化。本研究的目的是评估肾移植后血管并发症的演变，在一系列历史的外科预防措施的背景下。本文回顾了30多年来连续进行的3129例单中心肾移植。分析动脉或静脉血栓、狭窄和动脉瘤的发生与肾脏获取、准备和移植技术的关系。13.5%的受者发生血管并发症，移植肾功能平均下降3年。无肾静脉延伸的右肾移植、多支肾动脉移植、体外血管修复和端到端动脉吻合是不利的手术血管因素。在80%的病例中，移植肾动脉狭窄(TRAS)的非手术治疗是可能的。血管并发症的预防从熟练的外科医生获取器官开始。器官准备的目的是评估血管风险，选择器官，简化血管植入的解剖学约束。肾移植的三个手术步骤是决定术后血管并发症和移植肾功能持续时间的关键因素。
The main surgical changes in kidney procurement, preparation, and transplantation procedures occurred 20 years ago and were undertaken despite the inability to design randomized studies. The objective was to assess the evolution of vascular complications after kidney transplantation in a setting of surgical preventive measures in a historical series. A monocentric series of 3129 consecutive kidney transplantations performed over 3 decades was reviewed. The occurrence of arterial or venous thromboses, stenoses, and aneurysms was analyzed in relation with kidney procurement, preparation, and transplantation techniques. Vascular complications occurred in 13.5% of the recipients with a mean 3-year decrease in kidney graft function. The transplantation of a right kidney without renal vein extension, multiple renal arteries, ex vivo vascular repairs, and end-to-end arterial anastomoses were the unfavorable surgical vascular factors. It was possible to manage Transplant Renal Artery Stenosis (TRAS) nonsurgically in 80% of the cases. The prevention of vascular complications begins from the time of organ procurement by skilled surgeons. The aims of organ preparation are to evaluate the vascular risk, select the organs, and to simplify the anatomical constraints of vascular implantations. The three surgical steps of kidney transplantation are determinant in postoperative vascular complications and the duration of graft function.