移植腎動脈狹窄病患接受直接動脈支架置放方法的血管整型術治療後的長期結果 – 一個10年的病例世代研究

Long-Term Outcomes of Patients Treated with Primary Stenting for Transplant Renal Artery Stenosis: A 10-year Case Cohort Study

蘇峻弘(Chun-Hung Su)

指導教授 ： 翁國昌 ； 李孟智 ； 徐國雄

中山醫學大學/醫學院/醫學研究所/博士(2012年)

https://doi.org/10.6834/CSMU.2012.00041

摘要

背景資料
移植腎動脈狹窄病患接受直接動脈支架置放方法的血管整型術治療後可明顯減少血管再狹窄的問題，但至今無長期的追蹤報告可證實術後病患及移植腎臟是否有良好預後，本研究的目的就是希望藉由病患及移植腎臟的存活率和術後長期的移植腎功能來完整評估這個治療對病患。
研究材料及方法
這個一個長達十年的前瞻性病例追蹤世代研究，研究對象包括由西元1999年12月至2010年3月所有在中山醫學大學規則追蹤的744位接受腎臟移植的病患，經血管攝影確認有明顯移植腎動脈狹窄後接受直接動脈支架置放血管整型術治療的這18位病患為實驗組，剩餘所有的726位則是對照組，主要研究結果是比較兩組發生移植腎衰竭或死亡的差異，另外藉由長期追蹤的血壓及腎功能評估直接動脈支架置放血管整型術的長期療效。

結果
所有患者均成功完成直接動脈支架置放血管整型術，只有一位病患發生技術相關的併發症(5.6%)，實驗組平均追蹤時間為7.1 ± 3.7年，這段時間共有4位病患達到試驗終點，對照組平均追蹤時間為6.9 ± 2.4年，共有113位病患達到試驗終點，存活分析顯示兩組之間是沒有統計學上的差異的(log rank P=0.418)，移植腎動脈狹窄的改善對患者的普遍難以控制的高血壓及不良的腎功能有立即的改善及維持至少6年長期穩定的效果，只有一位病患(5.6%)在術後證實有再狹窄而須接受再次血管整形術，但再狹窄並非造成移植腎臟衰竭的病因。
結論
這是第一個有關移植腎動脈狹窄病患接受血管整型術治療的前瞻性長期病例世代研究，直接動脈支架置放術能使患者病程及預後都恢復到沒有腎動脈狹窄的情況，更證實其長期的療效及安全性都是令人信賴的，可提供臨床醫師更具證據力的參考。

關鍵字

腎臟移植 ； 移植腎動脈狹窄 ； 支架置放

並列摘要

Background The purpose of the present study was to evaluate graft and patient survival and long-term outcomes of primary endoluminal stenting (PES) as an initial treatment for transplant renal artery stenosis (TRAS).

Methods From December 1999 to March 2010, 744 consecutive patients undergoing renal transplantation were enrolled. Patients were divided into one of two groups: the study group, comprised of 18 patients who underwent PES for TRAS > 60%, and a control group, including the remaining 726 recipients who did not develop TRAS post-transplantation. Primary outcome measures were death-censored graft failure and all-cause mortality. The immediate and long-term effects of PES were evaluated by assessing blood pressure (BP) control and biochemical graft function.
Results The technical success rate for PES was 100%, and minor complication occurred in only one case (5.6% of the study group). With a mean follow-up of 7.1 ± 3.7 and 6.9 ± 2.4 years in the study and control groups, respectively, 4 patients in the study group and 113 patients in the control group reached the primary outcome (log rank P = 0.418). The reduction in stenosis resulted in immediate improvement in BP control and graft function, which persisted throughout the 6 year follow-up period. Restenosis occurred in only one patient (5.6%), but restenosis was not the cause of graft failure.

Conclusions This study indicated that both the long-term graft and patient survival were as good in TRAS patients treated with PES as in patients without TRAS. The data also supported the use of PES as an initial treatment for TRAS.

並列關鍵字

kidney transplantation ； transplant renal artery stenosis ； stents

參考文獻

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