Andreoni K A, Pelletier R P, Elkhammas E A, Davies E A, Bumgardner G L, Henry M L, Ferguson R M
University of Medical Center, University of Arizona, Tucson, USA.
Transplantation. 1999 Jan 27;67(2):262-6. doi: 10.1097/00007890-199901270-00013.
We had the impression that, although our renal transplant recipients with polycystic kidney disease (PKD) had excellent long-term renal graft function, they had an increased incidence of postoperative gastrointestinal (GI) complications.
Over a 10-year period (1987 through 1996), 1467 renal transplants were performed in 1417 patients; 145 of these transplants involved PKD recipients. In the PKD group, 18 patients (12.4%) developed a posttransplant complication necessitating GI surgery (PKD-GI), an incidence twice that in the non-PKD recipients (73 patients or 6.2%, non-PKD-GI).
PKD and non-PKD recipients displayed no significant difference in mortality. The PKD patients had better long-term renal graft survival than the non-PKD patients (P=0.08). There was no difference in mortality (P>0.6) or renal graft survival (P>0.6) between the PKD-GI and PKD-non-GI groups. The PKD-GI group had no increased mortality over the non-PKD-GI patients (P>0.6), despite a higher incidence of GI surgical complications in the PKD group versus the non-PKD group (overall: 12.4 vs. 6.2%, P<0.01; within 90 days of transplant: 7.6 vs. 3.3%, P<0.02) and a greater propensity for small and large bowel complications (overall: 9.0 vs. 2.6%; P< 0.001; less than 90 days: 6.9 vs. 2.0%, P<0.002). The PKD-GI recipients tended toward less long-term graft loss than their non-PKD-GI counterparts (11.1 vs. 27.4%; P=.22). The PKD-GI recipients suffered no acute rejection episodes within 90 days after their GI operation versus 11 of 73 non-PKD-GI recipients (O vs. 15.1%; P=0.075).
PKD recipients of renal grafts should be watched closely early after transplant because of their increased risk of GI complications. These complications resulted in no increase in mortality or graft loss compared to non-PKD recipients with GI complications despite the PKD group's higher incidence of bowel perforation and increased age at time of transplant.
我们有这样的印象，即尽管我们的多囊肾病（PKD）肾移植受者具有出色的长期肾移植功能，但他们术后胃肠道（GI）并发症的发生率有所增加。
在10年期间（1987年至1996年），对1417例患者进行了1467例肾移植；其中145例移植涉及PKD受者。在PKD组中，18例患者（12.4%）发生了需要进行GI手术的移植后并发症（PKD-GI），其发生率是非PKD受者（73例患者，6.2%，非PKD-GI）的两倍。
PKD和非PKD受者在死亡率方面无显著差异。PKD患者的长期肾移植存活率高于非PKD患者（P=0.08）。PKD-GI组和PKD非GI组在死亡率（P>0.6）或肾移植存活率（P>0.6）方面无差异。PKD-GI组与非PKD-GI患者相比，死亡率没有增加（P>0.6），尽管PKD组的GI手术并发症发生率高于非PKD组（总体：12.4%对6.2%，P<0.01；移植后90天内：7.6%对3.3%，P<0.02），并且发生小肠和大肠并发症的倾向更大（总体：9.0%对2.6%；P<0.001；少于90天：6.9%对2.0%，P<0.002）。PKD-GI受者的长期移植丢失倾向低于非PKD-GI受者（11.1%对27.4%；P=0.22）。PKD-GI受者在GI手术后90天内未发生急性排斥反应，而非PKD-GI受者中的73例中有11例发生（0对15.1%；P=0.075）。
由于PKD肾移植受者发生GI并发症的风险增加，因此在移植后早期应密切观察。尽管PKD组肠穿孔发生率较高且移植时年龄较大，但与有GI并发症的非PKD受者相比，这些并发症并未导致死亡率或移植丢失增加。
