患者再次肾移植体会 - 第三军医大学学报.doc

题名：多重高危因素患者肾移植1例报告并文献复习 通信作者：聂峰，地址：广西南宁市解放军303医院病理科，电E-mail:dajjnf@ [基金项目]广西自然科学基金（2013GXNSFAA019253）；广西壮族自治区主席资金（10169-05）；广西卫生厅自筹经费科研课题（Z2014350） 多重高危因素患者肾移植1例报告并文献复习( 聂 峰1，2，孙煦勇1， 秦 科1 ，董建辉1， 杨建均2 ，李美思1，(李壮江1( （530021南宁，解放军第303医院：移植医学研究院，广州军区器官移植中心，广西移植医学重点实验室1(；病理科2） [摘要] 目的 探讨一例具多重高危因素肾移植的疾病特点，提高对高危肾移植患者的临床处置水平。 方法 回顾性分析1例多重高危因素肾移植患者临床资料。女性45岁患者，因小儿麻痹症双下肢瘫痪并萎缩，患慢性肾衰竭行首次肾移植并妊娠后，移植肾功能衰竭行再次肾移植，术前检查群体反应性抗体阳性。供肾源自一名5岁儿童心死亡后捐赠器官，人组织相容性抗原错配3个，补体依赖性细胞毒试验阴性。术后予巴利昔单抗免疫诱导、激素冲击、“他克莫司+吗替麦考酚酯+泼尼松”口服方案抗排斥。 结果 术后移植肾功能顺利恢复正常并出院，但相继出现不完全性肠梗阻并尿瘘、不明原因尿瘘、急性排斥反应、肺部感染，最终因呼吸、循环衰竭而死亡。 结论 多重高危因素患者进行肾移植，需要根据具体情况进行严格的术前评估、供受者筛选，制订周密的围手术期和出院后治疗护理方案并密切随访和及时调整。 [关键词]危险因素；高致敏；器官捐献；儿童供肾；再次肾移植 One case report of renal transplantation with multiple risk factors and literature review NIE Feng1,2 ，SUN Xuyong1，QIN Ke1 ，DONG Jianhui1 ，YANG Jianjun2 ，LI Meisi1 ，LI Zhuangjiang1(1Institute of Transplant Medicine, 303 Hospital of People’s Liberation Army; Department of Organ Transplantation，Guangzhou Military Region ;Guangxi Key Laboratory for Transplantation Medicine;2Department of pathology，303 Hospital of People’s Liberation Army,Nanning, Guangxi Zhuang Autonomous Region,530021,China) [Abstract] Objective To investigate the characteristics of a case of renal transplantation with multiple risk factors in order to improve the level of its clinical diagnosis and treatment. Methods One case of renal transplantation with multiple risk factors was reported and the related literatures were reviewed in order to analyze and summarize the patient’s data. The patient was a 45-year-old female. She had been diagnosed with infantile paralysis that followed by paralysis and atrophy of the lower limbs. She received the first renal transplantation because of CRF and after the graft’s failure caused by subsequent pregnancy she received renal retransplantation. The graft was donated by a 5-year-old cardiac death child. Preoperative examinations showed the panel reactive antibody was posit