Hamidian Jahromi A, Raiss-Jalali G A, Roozbeh J
The Great Western Hospital, Swindon and Marlborough NHS Trust, No. 2 Chesterfield Close, Westlea, Swindon SN5 7DT, UK.
Transplant Proc. 2006 Sep;38(7):2003-5. doi: 10.1016/j.transproceed.2006.07.013.
Transplantation is the preferred treatment modality for many patients with end-stage renal diseases. Despite all the efforts, allograft dysfunction remains the most important cause of graft loss. Finding new factors that improve graft survival is mandatory.
This prospective study included 93 patients transplanted between April 1999 and July 2000. The duration of dialysis prior to transplantation was analyzed with respect to the values before and up to 3 years posttransplantation, including blood urea nitrogen (BUN), creatinine, and blood pressure (BP) using 1-month intervals and triglyceride, cholesterol, low-density lipoprotein and high-density lipoprotein at 3-month intervals. In this study, graft dysfunction was defined as serum creatinine >1.8 mg/dL. Hypertension was defined as BP > 140/90 on two occasions or treatment with antihypertensive medications. Patients in the hypertensive group were divided into controlled versus uncontrolled hypertensives.
The mean BUN and creatinine values of the patients prior to transplantation was 90 +/- 30 and 10.4 +/- 4, respectively. The patients had been on dialysis for an average of 4.7 years. Development of renal allograft dysfunction did not show any relationship to the duration of dialysis ptt. Patients with higher BUN and creatinine levels before transplantation experienced more episodes of renal allograft dysfunction in the 3-year posttransplant period (P < .05 for both BUN and creatinine). The relationship between BUN and creatinine prior to transplantation and risk of renal allograft dysfunction was more powerful among the group of uncontrolled hypertensives.
Intensive dialysis prior to transplantation may exert positive effects on long-term graft function and survival.
对于许多终末期肾病患者而言，移植是首选的治疗方式。尽管付出了诸多努力，但同种异体移植功能障碍仍是移植物丢失的最重要原因。寻找改善移植物存活的新因素势在必行。
这项前瞻性研究纳入了1999年4月至2000年7月期间接受移植的93例患者。分析移植前透析时间与移植后直至3年期间的各项指标，包括每隔1个月测定的血尿素氮（BUN）、肌酐和血压（BP），以及每隔3个月测定的甘油三酯、胆固醇、低密度脂蛋白和高密度脂蛋白。在本研究中，移植功能障碍定义为血清肌酐>1.8mg/dL。高血压定义为两次测量血压>140/90或接受抗高血压药物治疗。高血压组患者分为血压控制组和未控制组。
患者移植前的平均BUN和肌酐值分别为90±30和10.4±4。患者平均透析时间为4.7年。肾移植功能障碍的发生与移植前透析时间无关。移植前BUN和肌酐水平较高的患者在移植后3年内发生肾移植功能障碍的次数更多（BUN和肌酐均P<.05）。在未控制高血压组中，移植前BUN和肌酐与肾移植功能障碍风险之间的关系更为显著。
移植前强化透析可能对移植物的长期功能和存活产生积极影响。
