血液透析和腹膜透析对肾移植术后并发症和预后的影响

Influence of hemodialysis and peritoneal dialysis on complications and outcomes after renal transplantation

目的探讨血液透析（HD）与腹膜透析（PD）对肾移植术后并发症和预后的影响。方法回顾分析402例术前维持性透析超过3个月的同种异体尸体肾移植术患者的临床资料。按透析方式将患者分为HD组（303例）和PD组（99例），并对345例随访（30．2±15．2）月。比较术前HD和PD对肾移植术后受者和移植肾存活率以及肾移植术后并发症，包括急性排斥、移植肾功能延迟恢复（DGF）、感染、慢性排斥等的影响。结果除了术前平均透析时间PD组长于HD组，乙型肝炎（乙肝）感染率HD组明显高于PD组外，在原发病、年龄、性别、血压、血红蛋白、HLA配刑、冷热缺血时间、丙型肝炎感染等方面两组间差异无统计学意义。移植术后两组在DGF、急性排斥、慢性排斥、巨细胞病毒（CMV）感染和其他感染的发生率等方面差异无统计学意义。HD组术前透析时间〉12个月的患者急性排斥的发生率显著高于〈12个月的患者（P〈0．05）乙肝患者比非乙肌患者更易发生千多植肾丧失功能（19．23％比8．86％，P=0．021）、PD组乙肝痫毒阴性的患者术后感染发生率较低。术后患者1年和5年存活率在两组间差异无统计学意义（1年：HD94．34％，PD91．25％；5年：HD92．83％，PD90％）；同样移植肾1年和5年仔活率两组间差异也无统计学意义（1年：HD93．21％，PD96．25％；5年：HD87．17％，PD91．25％）、结论HD和PD对肾移植术后并发症、患者及移植性肾1年和5年存活率的影响相似，均可作为慢性肾衰竭患肯肾移植术前替代治疗。HD患者的急性排斥发生率随关透析时间的延长而增加，因此，缩短肾移植前透析时间将有助减少肾移植术肝并发症．

Objective To investigate the effects of hemodialysis （HD） and peritoneal dialysis （PD） on the complications and outeomes after renal transplantation. Methods Clinical data of 402 renal transplant recipients maintained on dialysis for more than 3 months were retrospectively studied and divided into 2 groups： HD group（n=303 ）and PD group（n=99）. Among them, 345 recipients were followed up for an average of （30.2±15.2） months. The iml）aet of HD and PD on the acute rejection, delayed graft function （DGF）, infection, chronic rejeetion and the graft and patient survival rates were analyzed. Results The mean dialysis duration was significantly longer in PD group and the hepatitis B infeetion rate was significantly higher in HD group. There were no signifieant differences between the HD and PD groups in regarding to primary disease for end-stage renal disease, age, gender, blood pressure, hemoglobin, HLA malch, hot and cold ischemia time, and hepatitis C virus infection. The incidence of DGF, acute and chronic rejection, and cytomegalovirus and other infections between HD and PD groups were not significantly different. However, the graft loss happened more frequently in hepatatis B patients than that in non hepatitis B patients （19.23% vs 8.86%, P=0.021 ）, and the post-transplant infection ocurred less in non hepatits B patients with PD. The acute rejection episodes were higher in HD patients who received pretransplant dialysis for more than 12 months （P〈0.05）. The overall recipients survival rates of HD and PD groups were similar （ 1-year： HD 94.34%, PD 91.25%; 5- year： HD 92.83%, PD 90%）, and the same as the graft survival rates in HD and PD groups （1- year： HD 93.21%, PD 96.25%; 5-year： HD 87.17%, PD 91.25%）. Conclusions The influences of PD and HD on the complications after renal transplantaton, 1-year and 5-year recipients and graft survival rates are similar, so both HD and PD can be chosen as the pretransplant dialysis modality. As the incidence of acute rejection increases with time in HD, it is better to shorten the time of pretransplant dialysis to decrease the complication.