无透析肾移植与透析后肾移植临床效果比较

The comparison of clinic effects induced by pre-emptive renal transplantation and transplantation after dialysis

目的:对比无透析肾移植和血透(HD)及腹透(PD)后肾移植的人/肾存活率、排斥反应发生率、移植肾功能延迟恢复(DGF)的发生率及感染情况。方法:回顾调查无透析肾移植病人50例,随机抽取术前基本情况相仿的HD及PD后肾移植各50例做为对照。结果:无透析组1年、3年人/肾存活率分别为98%/98%,94%/94%;HD组1、3年人/肾存活率分别为98%/96%,94%/90%;PD组1、3年人/肾存活率分别为96%/96%,94%/90%。3组比较无显著性意义(P>0.05)。无透析组急性排斥反应(AR)发生率8%,HD组18%,PD组14%,3组比较无透析组AR发生率明显低于其他2组,有显著性意义(P<0.05)。3组慢性排斥反应(CR)发生率均为4%,相比较无显著性意义(P>0.05)。无透析组DGF发生率10%,HD组22%,PD组18%。无透析组DGF发生率明显低于其他2组,有显著性差异(P<0.05)。无透析组术后巨细胞病毒(CMV)感染率为12%,HD组14%,PD组10%,3组比较无显著性差异(P>0.05)。无透析组术后肝炎患者4%,HD组14%,PD组8%,HD组感染率明显高于其他2组,有显著性差异(P<0.05)。结论:满足血肌酐<750μmol/L,血钾<6g/L,24h尿量>1000ml的尿毒症患者直接行肾移植术,安全可行,费用低。

Objective： To compare the therapeutic effect of pre-emptive renal transplantation and transplantation after dialysis （hemodialysis and peritoneal dialysis）. Methods： The data of 50 cases of preemptive renal transplantation were analyzed. The other two group of transplantation after more than 3 months of hemodialysis （50 cases） and peritoneal dialysis （50 cases） were selected as the control groups. The incidence rate of rejection, the survival rate of recipient/graft ,the rate incidence and infection of the delayed graft function （DGF） were observed. Results： The survival rate of recipient/graft on 1 and 3 years were 98%/98% and 94%/94% in pre-mptive renal transplantation group and which were similar as hemodialysis group （98% and 96%, 94% and 90%） and peritoneal dialysis group （96% and 96%, 94% and 90%） . No significant difference could be found among these three groups. Acute rejection occurred rarely in pre-emptive transplantation group （8% vs 18%/14%, P〈0.05）.The chronic rejection of these three groups occurred all 4% and no significant difference could be found among them. The identical finding also had been shown in the rate of delayed graft function （10% vs 22%/18%, P〈0.05）, and creatinine level had recovered by hemodialysis in all of DGF recipient finally. The rate of CMV were 12% in pre-emptive renal transplantation group and which were similar as hemodialysis group （14%） and peritoneal dialysis group （10%） . No significant difference could be found among these three groups. The HBV and HCV patients were 14% in hemodialysis group ,much higher than pre-emptive renal transplantation group （4%）and peritoneal dialysis group （8%）. Significant difference could be found among these three groups. Conclusion： Preemptive renal transplantation is a potent and safety＇ way to urinemia patients （Cr〈750 μ mol/L, K^＋〈6 g/L,total volume urine more than 1 000 ml）, as well as can reduce the cost.