生体腎移植後早期に移植床外腸骨動脈解離を来した1例

抄録

Patients with chronic renal failure have potential risks due to atherosclerosis and occasionally develop surgical complications, such as arterial dissection in regions of vascular anastomoses. We present a case of iliac artery dissection following kidney transplantation.

The patient was a male in his seventies with end-stage kidney disease primarily due to glomerulonephritis who had not been on chronic hemodialysis therapy. He underwent a kidney transplantation from a healthy living donor in his sixties, and the graft artery was sutured to the recipient’s right external iliac artery in side-to-end fashion. The recipient was reported to be negative anti-donor HLA preformed antibodies and had no other immunological risks.

The serum creatinine levels started to increase on day 13 post transplant, whereas the graft had been functioning immediately after transplantation. The ultrasound doppler examination indicated impaired blood perfusion in the transplanted kidney. Further examinations by angiography and intravascular ultrasound (IVUS) distinctively displayed an intimal flap in the right external iliac artery.

The patient was diagnosed with arterial dissection causing insufficient blood inflow to the graft. An intra-arterial stent was soon placed in the dissected artery by the interventional radiology technique. After this procedure, the intra-graft blood flow recovered and the patient’s serum creatinine levels decreased within two weeks.

We report a case of acute kidney injury of transplant due to external iliac artery dissection successfully treated with intra-arterial stent placement. It should be noted that older patients with chronic renal failure have a risk of arterial dissection of anastomosis sites, and IVUS is one of the useful devices for an appropriate diagnosis potentially leading to prompt therapy.