Badve Sunil V, Hawley Carmel M, McDonald Stephen P, Mudge David W, Rosman Johan B, Brown Fiona G, Johnson David W
Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia.
Nephrol Dial Transplant. 2006 Mar;21(3):776-83. doi: 10.1093/ndt/gfi248. Epub 2005 Nov 9.
There is limited information about the outcomes of patients commencing peritoneal dialysis (PD) after failed kidney transplantation. The aim of the present study was to compare patient survival, death-censored technique survival and peritonitis-free survival between patients initiating PD after failed renal allografts and those after failed native kidneys.
The study included all patients from the ANZDATA Registry who started PD between April 1, 1991 and March 31, 2004. Times to death, death-censored technique failure and first peritonitis episode were examined by multivariate Cox proportional hazards models. For all outcomes, conditional risk set models were utilized for the multiple failure data, and analyses were stratified by failure order. Standard errors were calculated by using robust variance estimation for the cluster-correlated data.
In total, 13,947 episodes of PD were recorded in 23,579 person-years. Of these, 309 PD episodes were started after allograft failure. Compared with PD patients who had never undergone kidney transplantation, those with failed renal allografts were more likely to be younger, Caucasian, New Zealand residents and life-long non-smokers with lower body mass index (BMI), poorer initial renal function and a longer period from commencement of the first renal replacement therapy to PD. On multivariate analysis, PD patients with failed kidney transplants had comparable patient mortality [weighted hazards ratio (HR) 1.09, 95% confidence interval (CI) 0.81-1.45, P = 0.582], death-censored technique failure (adjusted HR 0.91, 95% CI 0.75-1.10, P = 0.315) and peritonitis-free survival (adjusted HR 0.92, 95% CI 0.72-1.16, P = 0.444) with those PD patients who had failed native kidneys. Similar findings were observed in a subset of patients (n = 5496) for whom peritoneal transport status was known and included in the models as a covariate.
Patients commencing PD after renal allograft failure experienced outcomes comparable with those with failed native kidneys. PD appears to be a viable option for patients with failed kidney allografts.
关于肾移植失败后开始腹膜透析（PD）患者的预后信息有限。本研究的目的是比较肾移植失败后开始PD的患者与自体肾失败后开始PD的患者之间的患者生存率、死亡删失技术生存率和无腹膜炎生存率。
该研究纳入了ANZDATA登记处1991年4月1日至2004年3月31日期间开始PD的所有患者。通过多变量Cox比例风险模型检查死亡时间、死亡删失技术失败时间和首次腹膜炎发作时间。对于所有结局，对多重失败数据采用条件风险集模型，并按失败顺序进行分层分析。通过对聚类相关数据使用稳健方差估计来计算标准误差。
总共记录了23579人年中的13947次PD事件。其中，309次PD事件是在移植失败后开始的。与从未接受过肾移植的PD患者相比，肾移植失败的患者更可能较年轻、为白种人、是新西兰居民且为终生不吸烟者，其体重指数（BMI）较低、初始肾功能较差且从首次肾脏替代治疗开始到PD的时间较长。多变量分析显示，肾移植失败的PD患者与自体肾失败的PD患者在患者死亡率[加权风险比（HR）1.09，95%置信区间（CI）0.81 - 1.45，P = 0.582]、死亡删失技术失败（校正HR 0.91，95% CI 0.75 - 1.10，P = 0.315）和无腹膜炎生存率（校正HR 0.92，95% CI 0.72 - 1.16，P = 0.444）方面具有可比性。在已知腹膜转运状态并作为协变量纳入模型的一部分患者（n = 5496）中也观察到了类似结果。
肾移植失败后开始PD的患者的预后与自体肾失败的患者相当。PD似乎是肾移植失败患者的一个可行选择。
