腎移植により心機能の著明な改善をみた1例

Abstract

31歳男性.腎移植により心機能の著明な改善をみた1例を経験した.IgA腎症による慢性腎不全症で血液透析導入中, 労作時息切れを認め生体腎移植(ドナーは母親)を希望し入院したが, 高血圧, 頻脈, 貧血, 高度心機能低下を認め, 一旦退院し心機能改善の治療を行い, 約2ヵ月後に改善を認め再入院し, 母親(血液型一致)をドナーとして生体腎移植術を施行した.免疫抑制剤はサイクロスポリンA, アザチオプリン, プレドニゾロンの3剤を用いた.拒絶反応は認めず, 免疫抑制剤を徐々に減量し, 術後2ヵ月で退院した.血圧の低下および心機能の著明な改善を認め, 術後1年2ヵ月経過で拒絶反応は認めず経過良好である.腎不全で心機能低下を来した患者では, 腎移植そのものが心機能の治療になり得ると思われた

The recipient, a 31-year-old man, was diagnosed with severe diffuse hypokinesis of left ventricle and diastolic dysfunction by echocardiography before the renal transplantation. His left ventricular ejection fraction (LVEF) was 29%. Therefore we had to postpone the operation and tried to improve his cardiac function. We controlled his dry weight more strictly with hemodialysis and limited in take of salt and water to reduce preload of his heart and administered erythropoietin to improve his anemic condition. We administered angiotensin-converting enzyme inhibitors (ACEI) to control his blood pressure and reduce afterload of his heart. Two months later, his cardiac function was marked improved (LVEF, 29% to 47%), and he underwent renal transplantation. Five months after the operation, improvement of his cardiac function kept on being observed in spite of the cessation of treatment for his heart (LVEF, 47% to 68%). Successful renal transplantation can significantly improve the cardiac function of patients on maintenance dialysis.