肾移植前不同透析方式对肾移植预后的影响

The influence of different pre-transplant dialysis modalities on the prognosis of kidney transplantion

目的探讨肾移植前不同透析方式对肾移植术后早期及远期的影响。方法回顾性观察2006年1月至2017年12月在山西省第二人民医院行同种异体肾移植术的74例受者纳入本研究,其中腹膜透析(PD)组37例,血液透析(HD)组37例,术前透析方式均只采用单一透析方式。且为了控制供者相关的变量,采取了供者匹配的试验研究设计。结果PD组1年、5年、10年的人/移植肾存活率分别为100%/100%,97%/91.9%和89.5%/84.8%,HD组为97.3%/97.3%,92.2%/83.5%和84.5%/75.2%,经Log-rank检验,无论在人或是移植肾存活率差异均无统计学意义(P>0.05)。且术前透析方式不影响长期人[HR值95%Cl:0.21(0.02,2.11),P=0.19]及移植肾[HR值95%Cl:0.46(0.73,2.88),P=0.41]长期存活。术后PD组及HD组移植肾急性排斥反应(AR)(18.9%/24.3%,P=0.57),移植肾功能延迟恢复(DGF)(2.7%/5.4%,P=1.0),感染(13.5%/2.7%,P=0.19),淋巴瘘(2.7%/2.7%,P=1.0)及切口延迟愈合(16.2%/2.7%,P=0.11)的发生率差异均无统计学意义,且经Logsitic回归分析,术前透析方式对此无影响。结论血液透析和腹膜透析作为肾移植术前不同替代治疗方式对于移植受者早期及远期无明确的影响。

Objective To investigate the impact of pre-transplant dialysis modalities on short-term and long-term outcomes of kidney grafting.Methods Retrospectively included in this study were 74 recipients who underwent allogeneic kidney grafting at Shanxi Second Provincial People′s Hospital between January 2006 and December 2017.Of them,37 recipients were in the peritoneal dialysis(PD)group and 37 others were in the hemodialysis(HD)group to receive the preoperative dialysis given only in single modality.To control for donor-related variables,this study was conducted with a donor/recepient matching design.Results The 1-,5-and 10-y patient/kidney graft survival rates in PD group were 100%/100%,97%/91.9%and 89.5%/84.8%,respectively;and in HD group,97.3%/97.3%,92.2%/83.5%and 84.5%/75.2%,respectively.Log-rank test showed that there was no significant difference in patient or kidney graft survival(P>0.05),and that the preoperative dialysis modality did not interfere with long-term survival of patient[HR 95%CI:0.21(0.02,2.11),P=0.19]or kidney graft[HR 95%CI:0.46(0.73,2.88),P=0.41].After surgery,there were no significant differences between PD and HD groups in acute rejection(AR)(18.9%vs 24.3%,P=0.57),delayed graft function(DGF)(2.7%vs 5.4%,P=1.0),infection(13.5%vs 2.7%,P=0.19),lymphatic fistula(2.7%vs 2.7%,P=1.0)and delayed wound healing(16.2%vs 2.7%,P=0.11).Logistic regression analysis showed that these events were not correlated with the pre-transplant dialysis modality.Conclusion Hemodialysis and peritoneal dialysis as different alternative treatments pre-transplant have no definite effect on the short-and long-term outcomes in graft recipients.