ABSTRACT
Objective To explore the prevention and treatment strategies for the infectious renal artery rupture after renal transplantation of organ donation after citizens death (DCD).Methods The clinical data of 5 donors and their corresponding recipients with infectious renal artery rupture after renal transplantation were retrospectively analyzed with review of the literature.Results The corresponding donors of 5 recipients had the potential risk factors for donor-transmitted infection (DTI):1 case of traumatic rupture of small intestine,2 cases of digestive tract injury when resecting the donor kidney from DCD donors,1 case of severe pneumonia and 1 case of multiple renal contusion.The pathogenic microorganisms were found in the culture of kidney preservation solution,including klebsiella pneumoniae in 1 case,candida albicans in i case,enterococcus.No pathogens were detected in 1 case,and kidney preservation solution taken from the external hospital was not cultured in 1 case.The pathological examination on the resected renal grafts revealed the necrosis of the arteries and the infiltration of lymphocytes.The culture of bacteria and fungi in the removed vessel walls of renal grafts and the iliac tissues showed there were 2 cases positive for candida albicans (case 2 and case 4),1 case for cryptococcus neoformans (case 1),1 case for klebsiella pneumonia (case 5).No pathogenic bacteria were detected in 1 case,but the possibility of fungal infection was more likely.In case 1,the second kidney transplantation was performed 10 months later after artery re-transplantation,and the kidney function was normal during the follow-up period.In case 4,the second kidney transplantation was performed 2 months later after transplant nephrectomy due to the refractory rejection,the transplanted kidney experienced a rapid loss of graft function,and the blood dialysis was given continuously.The remaining 3 patients survived so far,waiting for re-transplantation.No case of bleeding occurred again in the 5 recipients.Conclusion Renal graft artery rupture is one of most severe complications after renal transplantation.It is the key for preventing infectious renal artery rupture to screen strictly infection of donors and recipients,and to use sensitive and wide coverage antimicrobial to the donors before the removal of donor kidney and during the perioperative period after renal transplantation.Early detection and operation as soon as possible is the only treatment to save the lives of the recipients.
ABSTRACT
Surgical complications are still an important cause of graft loss after kidney transplantation. The most serious of these complications is arterial anastomosis rupture, which may cause not only graft loss and lower limb ischemia but can also be fatal. This paper presents a case of life-threatening transplant renal artery rupture after cadaveric kidney transplantation in China. With regard to cadaveric kidney transplantation in China, the shortage of donor information and operative findings is an obstacle to the post-transplant evaluation and management of overseas transplant recipients. Moreover, a high incidence of surgical complications and infection are present in this population of patients;therefore, these patients should be monitored more closely.
Subject(s)
Humans , Aneurysm, False , Cadaver , China , Incidence , Ischemia , Kidney , Kidney Transplantation , Lower Extremity , Renal Artery , Rupture , Tissue Donors , TransplantsABSTRACT
Surgical complications are still an important cause of graft loss after kidney transplantation. The most serious of these complications is arterial anastomosis rupture, which may cause not only graft loss and lower limb ischemia but can also be fatal. This paper presents a case of life-threatening transplant renal artery rupture after cadaveric kidney transplantation in China. With regard to cadaveric kidney transplantation in China, the shortage of donor information and operative findings is an obstacle to the post-transplant evaluation and management of overseas transplant recipients. Moreover, a high incidence of surgical complications and infection are present in this population of patients;therefore, these patients should be monitored more closely.