未透析的尿毒症患者直接进行肾移植的临床可行性研究

The clinical feasibility study on kidney transplantation for uremia patients without prior dialysis

目的探讨未透析的尿毒症患者直接进行肾移植的临床可行性和优越性。方法回顾性分析146例未透析直接行肾移植的尿毒症患者(未透析组)和同期653例透析后肾移植患者(透析组)的临床资料,并将两组资料进行统计学比较。结果未透析组和透析组术前肝炎病毒感染率分别为5．48％和19．14％,差异有统计学意义(P<0．05)。未透析组和透析组术后血肌酐恢复正常的时间及术后1个月的血红蛋白和白蛋白水平差异均无统计学意义(P>0．05)。未透析组术后急性排斥反应、肾功能延迟恢复和肝功能损害的发生率分别为19．18％、6．16％和9．59％,透析组分别为33．54％、13．02％和25．57％,2组比较,差异均有统计学意义(P<0．05);2组患者术后高血压和感染的发生率比较,差异均无统计学意义(P>0．05)。未透析组人／肾1年存活率均为98．63％,3年存活率均为95．95％。透析组人／肾1年存活率为97．24％/95．71％,3年存活率为94．37％／89．20％;2组比较,差异均无统计学意义(P>0．05)。结论未透析患者肾移植与透析后肾移植的临床治疗效果相当,并可避免透析的并发症和输血致敏,且术后急性排斥发生率低。因此,未透析的尿毒症患者直接行肾移植具有较明显的优势,临床上是完全可行的。

Objective To evaluate the feasibility and advantages of kidney transplantation for uremic patients without prior dialysis. Methods The clinical data of 146 uremic patients who presented for kidney transplantation without prior dialysis were retrospectively analyzed and compared with those of 653 dialysis patients undergoing kidney transplantation. Results The incidence of hepatitis was 5.48 % in the nonuse dialysis group and 19.14 % in the dialysis group prior transplantation with the difference being significant. After transplantation, there was no significant difference in the time of plasma creatinine returning to normal level between the nonuse dialysis group and the dialysis group. One month after transplantation, the levels of hemoglobin and albumin in the nonuse dialysis group were not significantly different from those in the dialysis group. The acute rejection rate, DGF and hepatic function impairment rate were 19.18 %, 6.16 %, 9.59 % in nonuse dialysis group, while 33.54 %, 13.02 %, 25.57 % in dialysis group respectively, with the difference being significant. There were no significant differences in infectious rate and hypertension rate between the two groups. The patient/graft 1-year survival rate in the nonuse dialysis group and the dialysis group was 98.63% and 97.24 % respectively, and the patient/graft 3-year survival rate was 95.95 % and 89.20 %, respectively （all P〉0.05）. Conclusions The kidney transplantation without prior dialysis offered comparable patient/graft survival to kidney transplantation with prior dialysis and avoided the dialysis complications and sensitization of transfusion, while reduced the risk of acute rejection. Therefore, uremic patients may be considered to receive the kidney transplantation without prior dialysis in clinic.