A case of kidney transplantation from a deceased donor with acute kidney injury due to rhabdomyolysis
A case of kidney transplantation from a deceased donor with acute kidney injury due to rhabdomyolysis
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横纹肌溶解症急性肾损伤死者供体肾移植1例
DOI：
10.1159/000530340
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发表时间：
2023
期刊：
影响因子：
2.5
通讯作者：
Tanaka Hiroshi
中科院分区：
文献类型：
--
作者：
Takada Yusuke;Hotta Kiyohiko;Moriya Kimihiko;Sasaki Hajime;Takamoto Daiji;Higuchi Haruka;Tanabe Tatsu;Minami Keita;Iwasaki Sari;Tsuji Takahiro;Tanaka Hiroshi
横纹肌溶解引起的急性肾损伤（阿基）是由于肾小管中肌红蛋白管型沉积引起的肾缺血或急性肾小管坏死。由于横纹肌溶解症而发生阿基的供体不是移植禁忌症。然而，暗红色的肾脏引起了移植后肾功能减退或原发性无功能的担忧。我们报告的情况下，34岁的男子有15年的历史，血液透析慢性肾功能衰竭，由于先天性异常的肾脏和尿路。患者接受了一名心脏死亡的年轻女性的肾移植。运送时供体的血清肌酐（sCre）水平为0.6 mg/dL，肾脏超声检查显示肾脏形态或血流无异常。她的血清肌酐激酶水平在股动脉插管后58小时升高至57，000 IU/L，sCre水平恶化至1.4 mg/dL，表明阿基是由于横纹肌溶解症。然而，由于供体的尿量保持不变，因此认为sCre升高没有问题。同种异体移植物在采购时外观呈暗红色。离体肾灌注良好，但暗红色未见改善。0-h活检显示肾小管上皮变平，30%的肾小管无刷状缘和肌红蛋白管型。诊断为横纹肌溶解相关肾小管损伤。术后第14天停止血液透析。术后24天，移植肾功能进展良好（sCre 1.18 mg/dL），患者出院。移植后1个月的活检显示肌红蛋白管型消失，肾小管上皮损伤改善。移植后24个月，患者的sCre水平约为1.0 mg/dL，他表现良好，无并发症。
Acute kidney injury (AKI) due to rhabdomyolysis occurs because of renal ischemia or acute tubular necrosis due to the deposition of myoglobin casts in the renal tubules. Donors with AKI due to rhabdomyolysis are not contraindication for transplantation. However, the dark red kidney raises concerns about renal hypofunction or primary nonfunction after transplantation. We report the case of a 34-year-old man with a 15-year history of hemodialysis for chronic renal failure due to congenital anomalies of the kidney and urinary tract. The patient received a renal allograft from a young woman who suffered cardiac death. The serum creatinine (sCre) level of the donor at the time of transport was 0.6 mg/dL, and renal ultrasonography revealed no abnormalities in renal morphology or blood flow. Her serum creatinine kinase level increased to 57,000 IU/L 58 h after femoral artery cannulation and sCre level worsened to 1.4 mg/dL, suggesting AKI due to rhabdomyolysis. However, since the urine output of the donor was maintained, the sCre elevation was thought to be nonproblematic. The allograft had a dark red appearance at the time of procurement. The perfusion of the isolated kidney was good, but the dark red color did not improve. A 0-h biopsy showed flattening of the renal tubular epithelium and absence of the brush border and myoglobin casts in 30% of the renal tubules. Rhabdomyolysis-related tubular damage was diagnosed. Hemodialysis was discontinued on postoperative day 14. Twenty-four days after the operation, the transplanted kidney function progressed favorably (sCre 1.18 mg/dL), and the patient was discharged. Protocol biopsy 1 month after transplantation showed disappearance of myoglobin casts and improvement in renal tubular epithelial damage. The patient’s sCre level was approximately 1.0 mg/dL 24 months after transplantation, and he is doing well without complications.