Passalacqua J A, Wiland A M, Fink J C, Bartlett S T, Evans D A, Keay S
Department of Medicine, University of Maryland School of Medicine, Baltimore 21201, USA.
Transplantation. 1999 Aug 27;68(4):535-40. doi: 10.1097/00007890-199908270-00016.
Infection is a frequent postoperative complication in renal transplant recipients. However, little information is available concerning the effect of pretransplantation dialysis modality on posttransplantation complications including infection. We therefore evaluated the effect of hemodialysis (HD) versus peritoneal dialysis (PD) on the incidence of postoperative infection as well as several other posttransplantation outcomes.
A retrospective analysis was performed using medical records covering the period 30 days after transplantation of 156 dialysis patients who underwent renal transplantation at a single center during a 22-month period. Of these patients, 103 received only HD, 32 received only PD, 13 received PD in the past and HD immediately before transplantation (PH/HD), and 8 received HD in the past and PD immediately before transplantation (HD/PD). The presence of culture-proven infection, types of infecting organisms, length of initial hospital stay, and incidence of rejection during the first 30 days after transplantation were determined for each patient.
All groups were similar with regard to age, race, gender, underlying disease, donor type, incidence of delayed graft function, and perioperative antibiotic prophylaxis. There were more infectious complications within 30 days after transplantation in patients on PD just prior to transplantation (PD and HD/PD) than in HD patients (67.5% vs. 25.9%, P<0.00001). When types of infectious organisms were assessed, PD patients were found to have a greater incidence of infections with microorganisms that colonize human skin (P<0.0001). The median length of hospital stay was 3 days longer for PD patients and 6.5 days longer for HD/PD patients than for patients receiving HD (P=0.01 and 0.04), and PD and HD/PD patients were more likely to have an episode of rejection than HD patients (P=0.02).
Renal replacement therapy with PD immediately before transplantation negatively affects outcome as compared with HD, predisposing patients to a greater incidence of postoperative infections and rejection and a longer hospital stay. Further study in a randomized controlled trial may help determine how adjustment of the dialysis method can optimize transplantation outcome.
感染是肾移植受者常见的术后并发症。然而，关于移植前透析方式对包括感染在内的移植后并发症的影响，目前可用信息较少。因此，我们评估了血液透析（HD）与腹膜透析（PD）对术后感染发生率以及其他几种移植后结局的影响。
对156例在22个月期间于单一中心接受肾移植的透析患者移植后30天内的医疗记录进行回顾性分析。这些患者中，103例仅接受HD，32例仅接受PD，13例过去接受PD且移植前即刻接受HD（PH/HD），8例过去接受HD且移植前即刻接受PD（HD/PD）。确定每位患者是否存在经培养证实的感染、感染病原体类型、首次住院时间以及移植后前30天内的排斥反应发生率。
所有组在年龄、种族、性别、基础疾病、供体类型、移植肾功能延迟恢复发生率以及围手术期抗生素预防方面相似。移植前接受PD的患者（PD组和HD/PD组）移植后30天内的感染并发症比HD患者更多（67.5%对25.9%，P<0.00001）。在评估感染病原体类型时，发现PD患者感染定植于人体皮肤的微生物的发生率更高（P<0.0001）。PD患者的中位住院时间比接受HD的患者长3天，HD/PD患者比接受HD的患者长6.5天（P=0.01和0.04），并且PD和HD/PD患者比HD患者更易发生排斥反应（P=0.02）。
与HD相比，移植前即刻采用PD进行肾脏替代治疗对结局有负面影响，使患者术后感染和排斥反应的发生率更高，住院时间更长。在随机对照试验中进行进一步研究可能有助于确定如何调整透析方法以优化移植结局。
