移植后早期肾静脉血栓的意外成功:1例报告及文献复习。

Clinical Nephrology. Case Studies Pub Date : 2021-02-19 eCollection Date: 2021-01-01 DOI:10.5414/CNCS110407
Joana Eugénio Santos, Ana Gaspar, Sara Querido, Cristina Jorge, André Weigert, Henrique Mesquita Gabriel, António Martinho, Domingos Machado
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引用次数: 0

摘要

背景:移植肾静脉血栓形成可导致移植肾术后早期丢失。这种诊断有时难以捉摸,需要强烈的怀疑。另一方面,一些作者已经认识到同种异体肾静脉血栓形成的危险因素,但对于这种并发症,既没有推荐预防方法,也没有推荐治疗方法。病例介绍:我们提出了一个病例报告,早期同种异体移植肾静脉血栓形成,之前的股总深静脉血栓形成的受体第三肾移植。尽管采用低分子肝素治疗股总深静脉血栓形成,肾功能逐渐改善至最低血清肌酐0.51 mg/dL,但患者在术后第5天突然出现无尿。多普勒超声强烈提示同种异体肾静脉血栓的诊断。患者行球囊导管穿刺静脉取栓,随后行肝素灌注。经过4天的无尿和多次输血,当考虑同种异体肾切除术时,利尿突然恢复。随访1年后,患者肾功能仍正常。结论:本病例报告显示同种异体移植肾静脉血栓形成合并深静脉血栓形成在移植第一周成功治疗,采用球囊导管和吸入性静脉血栓取栓后灌注无分剂肝素。作者建议这项技术作为移植肾静脉血栓的治疗选择。然而,他们强调了个体化治疗的重要性,并提醒说,延误可能会危及手术的潜在益处。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Unexpected success in early post-transplantation renal vein thrombosis: A case report and literature review.

Unexpected success in early post-transplantation renal vein thrombosis: A case report and literature review.

Unexpected success in early post-transplantation renal vein thrombosis: A case report and literature review.

Unexpected success in early post-transplantation renal vein thrombosis: A case report and literature review.

Background: Allograft renal vein thrombosis can cause graft loss during the early postoperative period. This diagnosis is sometimes elusive, requiring a strong suspicion. On the other hand, several authors have recognized risk factors for allograft renal vein thrombosis, but neither a preventive approach nor a treatment have been recommended for this complication.

Case presentation: We present a case report of early allograft renal vein thrombosis, preceded by femoral common deep vein thrombosis in a recipient of a third kidney transplant. Despite femoral common deep vein thrombosis treatment with low-molecular-weight heparin and progressive improvement of renal function to a nadir serum creatinine of 0.51 mg/dL, the patient experienced a sudden episode of anuria on postoperative day 5. Doppler ultrasonography strongly suggested the diagnosis of allograft renal vein thrombosis. The patient underwent balloon catheter and aspiration venous thrombectomy, followed by unfractionated heparin perfusion. After 4 days of anuria and multiple blood transfusions, when allograft nephrectomy was contemplated, diuresis suddenly resumed. After 1 year of follow-up, the patient still has a normal renal function.

Conclusion: This case report shows successful treatment of allograft renal vein thrombosis associated with deep vein thrombosis in the first week of transplantation, using balloon catheter and aspiration venous thrombectomy followed by perfusion of unfractionated heparin. The authors suggest this technique as a treatment option for transplant renal vein thrombosis. However, they reinforce the importance of individualized treatment and they remind that a delay may jeopardize the potential benefit of the procedure.

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