Clinical Analysis Of Renal Autotransplantation In The Treatment Of Renal Artery Stenosis (Report Of Nine Cases)

ObjectiveTo observe the safety and efficacy of renal autotransplantation(RAT) for the treatment of renal artery stenosis(RAS). MethodsFrom May 2007 to May 2015,9 patients with renal artery stenosis were treated by the renal autotransplantation in our hospital.Their clinical data and follow-up results were analyzed retrospectively.Recorded the operation time,renal warm ischemia time,renal cold ischemia time,the intraoperative blood loss,postoperative hospital stay,intraoperative and postoperative complications.Patients' serum creatinine levels,split renal function,blood pressure and the application of antihypertensive drugs during the perioperative period and follow-up period were also recorded. ResultsAll casess were successfully performed renal autotransplantation.8 cases were treated by open nephrectomy,the operation time was 196.38±10.24mins;the renal warm ischemia time was 17.25±1.67s;the renal cold ischemia time was 75.38±3.54mins;the intraoperative blood loss was 298.75±19.59ml;the postoperative hospital stay was 14.75±1.49 days.And 1 case was treated by retroperitoneal laparoscopic nephrectomy,the operation time was 246mins;the renal warm ischemia time was 150s;the renal cold ischemia time was 83mins; the intraoperative blood loss was 270ml;the postoperative hospital stay was 15 days.There were no severe complications.The double-J stent were removed 1 month after the operation. Patients were followed up for 9 to 72 months.Color doppler ultrasound and renal artery CTA confirmed all cases were no transplant renal artery narrow signs.All cases' renal function of the transplant kidney were improved.The serum creatinine levels were in the normal range and no deterioration of renal function occurred.During the follow-up period, there was 1 case of bilateral RAS patient's serum creatinine level elevated at the 6th month after the operation.The remaining 8 patients' serum creatinine levels were in the normal range.2 cases of unilateral RAS patients had 3 kinds of antihypertensive drugs before the operation,and decreased to 2 kinds of antihypertensive drugs after the operation,the blood pressure controlled in the normal range.At the 24 th month after the operation,they had 1 kinds of antihypertensive drugs,blood pressure was normal.The other 2 cases of unilateral RAS patients and 4 cases of bilateral RAS patients were reduced the types and the doses of antihypertensive drugs in 7 to 14 days after the operation,the blood pressure were significantly improved;1 case of unilateral RAS patient had 3 kinds of antihypertensive drugs,before the operation,and decreased to 2 kinds of antihypertensive drugs 6 months after the operation.The average systolic blood pressure was 146 mmHg,the average diastolic blood pressure was 95 mmHg;1 case of unilateral RAS patient and 3 cases of bilateral RAS patients had an average of 3 kinds of antihypertensive drugs before the operation,and decreased to had an average of 1.5 kinds of antihypertensive drugs 24 months after the operation.The average systolic blood pressure of was 136 to 145 mmHg,the average diastolic blood pressure was 86 to105 mmHg;1 case of bilateral RAS patient had 4 kinds of antihypertensive drugs before the operation,and decreased to 2 kinds of antihypertensive drugs 72 months after the operation,the average systolic blood pressure was 145 mmHg,the average diastolic blood pressure was 96 mmHg.1 case of bilateral RAS patient had 4 kinds of antihypertensive drugs before the operation,and decreased to 2 kinds of antihypertensive drugs after the operation,the blood pressure was significantly improved.At the 6th months after the operation,as the abdominal aortic occlusion caused by the abdominal aortitis progress,the transplant kidney hypoperfusion and renal insufficiency occured.The patient's blood pressure was poorly controlled.The transplant renal perfusion was recovery after the ascending aorta and abdominal aorta bypass.The serum creatinine level decreased to normal.The patient's blood pressure was also controlled.Continue to follow up for 8 months,the patient had 2 kinds of antihypertensive drugs,the blood pressure controlled in the normal range,the renal function was normal and the transplant renal function was good. ConclusionsThe application of renal autotransplantation in the treatment of renal artery stenosis,was safety,effective,less complication and with high success rate.After the operation,the split renal function of patient's surgical intervention side renal can be effective improved and the control rate of hypertension was high.For the RAS patients with sufficient length of the normal diameter of the renal artery and the bilateral RAS patients with functional solitary kidney,especially for the RAS patients with restenosis after the interventional treatment,renal autotransplantation have a certain advantage.It was an effective treatment for renal artery stenosis.The short-term curative effect was satisfactory,long-term effect needed further observation.