| 特集名 | 透析医療と他科連携 -- 見逃しやすい疾患を中心に | |
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| 題名 | 腎移植科【移植腎機能廃絶と血液透析再導入に伴う諸問題】 | |
| 発刊年月 | 2011年 02月 | |
| 著者 | 森田 研 | 北海道大学病院血液浄化部 |
| 【 要旨 】 | 移植腎機能廃絶例における安全な透析再導入に当たり，重要となる問題点を検討した．移植腎廃絶につながる腎機能低下の原因は慢性移植腎症が多く，血液透析再導入の時期を適切に検討し，血液透析アクセスの確保を行いつつ腎機能悪化に伴う合併症の予測を行うことが必要である．具体的な対策としては非移植症例における透析導入と大きく異なる点として免疫抑制薬の調節，再導入時におけるメンタルケア，再導入における医療福祉の早期からの対応，移植腎の温存や二次腎移植を見据えた診療を心がけることがあげられる． 移植腎機能廃絶例における合併症の頻度は感染症が最多であり，免疫抑制薬の適切な減量，中止を症例ごとに十分配慮して行うことが必要である．また，心血管系の合併症は重篤になる場合がある．安全な透析療法への移行，再移植の可能性などをふまえ，診療科を超えた医師並びに多業種の協力によるチーム医療で患者教育やサポートをしっかり行うことにより透析再導入の遅れに伴う肺水腫などの合併症を未然に防ぐ努力が重要である． |
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| Theme | Working in Cooperation with Other Departments for Dialysis Treatment -- Centered Mainly on Easily Overlooked Conditions | |
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| Title | Management of post kidney transplant end stage patients | |
| Author | Ken Morita | Blood Purification Center, Hokkaido University Hospital |
| [ Summary ] | Even though the number of patients who lose allograft functions in the early post-transplant period has decreased, the initiation of renal replacement therapy (RRT) should be carefully considered. We evaluated safe clinical strategies for patients who underwent RRT after kidney transplantation due to renal allograft dysfunction. The reasons for graft loss were chronic allograft nephropathy primarily, followed by acute cellular rejection, recurrent renal disease and other conditions. RRT in patients who have experienced graft loss should be treated in consideration of dialysis access site preparation and modulation of immunosuppressive therapy to avoid complications related to renal dysfunction. Serum creatinine levels observed in patients with graft loss were approximately the same as those observed in non-transplanted end-stage renal disease patients. It is important for patients who have lost allograft function to have reduced immunosuppressive therapy, psychological care, and socio-economic support and sparing of renal allograft for the possibility of retransplantation in the future. At graft loss complications was found in 60 % of the cases. There were viral and bacterial infections in many cases. In order to avoid these infections, we must reduce and withdraw immunosuppressive agents properly. Cardiovascular complications were found in a small number of patients, and sometimes became life threatening. Comprehensive care for these patients including RRT induction and patient education, should be performed with diverse medical staff efforts in order to avoid the delay of RRT execution and exessive immunosuppression in association with graft loss. |
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