Vats A N, Donaldson L, Fine R N, Chavers B M
Department of Pediatrics, Children's Hospital of Pittsburgh, Pennsylvania, USA.
Transplantation. 2000 Apr 15;69(7):1414-9. doi: 10.1097/00007890-200004150-00035.
There are no large studies of the effect of pretransplant dialysis status on the outcome of renal transplantation (Tx) in children. This study evaluated the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) registry data for the outcome of Tx in pediatric patients who either (1) received their transplants preemptively or (2) were maintained on dialysis before receiving their transplants.
We compared graft survival and patient survival rates, incidence of acute tubular necrosis (ATN), acute rejection episodes, and causes of graft failure in peritoneal dialysis (PD) patients with those maintained on hemodialysis (HD) and those undergoing preemptive Tx (PTx).
Primary Tx was performed in 2495 children (59% male; 61% Caucasian; 1090 PD, 780 HD, 625 PTx) between 1/1/1992 and 12/31/1996. The overall graft survival rates of the PD and HD groups were similar, but were less than that of the PTx group (3-year: 82% PD and HD, 89% PTx, overall P = 0.0003). Improved graft survival in the PTx group was present only in recipients of grafts from living donors. There was no difference in the overall patient survival rate at 3 years, or in time to first acute-rejection episodes in the three groups. The incidence of ATN in the first 7 days post-Tx was higher in PD and HD patients than in PTx patients (11% PD and 12% HD vs. 2% PTx, P<0.001; HD vs. PD, P = NS). The major single cause of graft failure in each group was: PD, vascular thrombosis (200%); HD, chronic rejection (27%); PTx, acute and chronic rejection (21% each).
NAPRTCS data show that graft survival is improved in patients receiving PTx, compared with those receiving PD and HD. Graft loss resulting from vascular thrombosis is more common in children who receive PD than in those receiving HD.
目前尚无关于移植前透析状态对儿童肾移植（Tx）结局影响的大型研究。本研究评估了北美儿科肾移植协作研究（NAPRTCS）登记数据，以了解以下两类儿科患者的Tx结局：（1）接受抢先移植的患者；（2）在接受移植前接受透析治疗的患者。
我们比较了腹膜透析（PD）患者、接受血液透析（HD）的患者以及接受抢先Tx（PTx）的患者的移植物存活率、患者存活率、急性肾小管坏死（ATN）发生率、急性排斥反应发生率以及移植物失败的原因。
1992年1月1日至1996年12月31日期间，对2495名儿童进行了首次Tx（59%为男性；61%为白种人；1090例PD患者，780例HD患者，625例PTx患者）。PD组和HD组的总体移植物存活率相似，但低于PTx组（3年：PD组和HD组为82%，PTx组为89%，总体P = 0.0003）。PTx组移植物存活率的提高仅见于活体供肾受者。三组患者3年时的总体存活率以及首次急性排斥反应发生时间无差异。Tx后前7天ATN的发生率在PD和HD患者中高于PTx患者（PD组为11%，HD组为12%，PTx组为2%，P<0.001；HD组与PD组比较，P =无显著性差异）。每组移植物失败的主要单一原因分别为：PD组，血管血栓形成（200%）；HD组，慢性排斥反应（27%）；PTx组，急性和慢性排斥反应（各21%）。
NAPRTCS数据显示,与接受PD和HD的患者相比，接受PTx的患者移植物存活率更高。接受PD治疗的儿童血管血栓形成导致的移植物丢失比接受HD治疗的儿童更常见。
