接受腹膜透析的终末期肾病患者在心脏或心肺移植后的结局

Outcome in patients with end-stage renal disease following heart or heart--lung transplantation receiving peritoneal dialysis.

作者信息

Jayasena S D, Riaz A, Lewis C M, Neild G H, Thompson F D, Woolfson R G

机构信息

Department of Nephrology, Middlesex Hospital, UCLH Trust, London, UK.

出版信息

Nephrol Dial Transplant. 2001 Aug;16(8):1681-5. doi: 10.1093/ndt/16.8.1681.

DOI:10.1093/ndt/16.8.1681

PMID:11477174

Abstract

BACKGROUND

End-stage renal disease (ESRD) complicates 5--10% of heart and heart--lung transplant patients. We report our experience of peritoneal dialysis (PD) in 17 such patients.

METHODS

Between March 1995 and February 1999, 13 heart transplant and four heart--lung transplant patients (11 male, 6 female) joined our PD programme (10 continuous ambulatory PD, seven automated PD). Median time from heart or heart--lung transplantation to ESRD was 9 years (range 1--13 years), and median age at introduction of renal replacement therapy was 51 years (range 23--66 years). The frequency of exit-site infections, peritonitis, and PD survival (including technique failure and death) in the transplant group (TxP) was calculated retrospectively. These were compared with two contemporary control groups: PD patients immunosuppressed for other indications (ISP, n=19) and, all other patients recruited onto the PD programme (NISP, n=132).

RESULTS

Median follow-up was 10 months (range 2--27 months) for TxP, 7 months (range 2--29 months) for ISP, and 14 months (range 1--48 months) for NISP groups. The frequency of exit-site infections was similar in each group: 1 in 26 months for TxP; 1 in 30 months for ISP, and 1 in 27 months for NISP (P=NS). The frequency of peritonitis was greater in the TxP group at 1 in 15 months, compared with 1 in 20 months for ISP and 1 in 29 months for NISP (TxP vs NISP, P<0.05). PD failure following infection was 23.5% for TxP, 10.5% for ISP, and 12.9% for NISP. Actuarial PD survival at 24 months was only 25.2% in the TxP group compared with 79% in the NISP group. There were no deaths related to immediate complications of PD.

CONCLUSIONS

Increased risk of PD peritonitis and reduced PD survival is reported in this cohort of 17 heart and heart--lung recipients with ESRD. Nevertheless, for patients with severely impaired cardiac function, PD may still offer therapeutic advantage.

摘要

背景

终末期肾病（ESRD）使5%至10%的心脏和心肺移植患者病情复杂化。我们报告了17例此类患者的腹膜透析（PD）经验。

方法

1995年3月至1999年2月，13例心脏移植患者和4例心肺移植患者（11例男性，6例女性）加入了我们的PD项目（10例持续非卧床腹膜透析，7例自动化腹膜透析）。从心脏或心肺移植到ESRD的中位时间为9年（范围1至13年），开始肾脏替代治疗时的中位年龄为51岁（范围23至66岁）。回顾性计算移植组（TxP）的出口处感染、腹膜炎和PD存活（包括技术失败和死亡）的发生率。将这些与两个同期对照组进行比较：因其他适应症接受免疫抑制的PD患者（ISP，n = 19），以及所有其他加入PD项目的患者（NISP，n = 132）。

结果

TxP组的中位随访时间为10个月（范围2至27个月），ISP组为7个月（范围2至29个月），NISP组为14个月（范围1至48个月）。每组出口处感染的发生率相似：TxP组为每26个月1次；ISP组为每30个月1次，NISP组为每27个月1次（P = 无显著性差异）。TxP组腹膜炎的发生率更高，为每15个月1次，而ISP组为每20个月1次，NISP组为每29个月1次（TxP组与NISP组比较，P < 0.05）。感染后PD失败率TxP组为23.5%，ISP组为10.5%，NISP组为12.9%。TxP组24个月时的PD精算生存率仅为25.2%，而NISP组为79%。没有与PD即刻并发症相关的死亡。