Nunes P, Mota A, Alves R, Figueiredo A, Parada B, Macário F, Rolo F
Department of Urology and Renal Transplantation, Hospitais da Universidade de Coimbra, 3000 Coimbra, Portugal.
Transplant Proc. 2007 Oct;39(8):2483-5. doi: 10.1016/j.transproceed.2007.07.035.
Our objective was to study the influence on transplant outcome of unilateral native nephrectomy of massively enlarged kidneys at the time of renal transplantation among patients with end-stage renal disease owing to autosomal-dominant polycystic kidney disease (ADPKD).
We studied 159 renal transplants in patients with ADPKD divided into two groups according to the need to perform a unilateral native nephrectomy owing to enlarged kidneys (N+; n = 143) versus those not (N0; n = 16) needing this procedure. Parameters related to the donors, grafts, recipients, and operative data were correlated with short- and long-term outcomes. The groups were homogeneous in terms of recipient and donor ages, genders, HLA compatibilities, and length of pretransplant dialysis.
When no nephrectomy was needed surgery length was shorter (N0, 3.01 vs. N+, 4.23 hours; P < .001), less intraoperative crystalloids were infused (N0, 1.84 vs. N+, 2.76 L; P < .001), and less plasma (N0, 2.07 vs. N+, 2.93 U; P < .05), or blood (N0, 1.05 vs. N+, 1.81 U; P < .05) transfusions were required. Hospital stay was similar (N0, 12.70 vs N+, 16.50 days; P not significant [NS]). There was only one urologic complication in the nephrectomy group. There were no differences (P = NS) in rates of delayed graft function (N0, 19.9%; N+, 12.5%), acute rejections (N0, 25.5%; N0, 33.3%), chronic allograft dysfunction (N0, 15.8%; N+, 28.6%). Graft function at 1 month as well as 1 and 5 years were comparable. Patient and graft survivals were similar at 1 and 5 years. There were no differences in the causes of graft loss or patient death.
In patients with ADPKD native nephrectomy of massively enlarged kidneys may be safely performed during the transplant procedure with no repercussions on the length of hospital stay, graft short- and long-term function and patient survival. However the procedure eads to a longer operative time and greater need for fluids and blood products.
我们的目标是研究在因常染色体显性多囊肾病（ADPKD）导致终末期肾病的患者中，肾移植时对一侧肿大肾脏进行单侧自体肾切除术对移植结果的影响。
我们研究了159例ADPKD患者的肾移植情况，根据是否因肾脏肿大需要进行单侧自体肾切除术将患者分为两组（N+组；n = 143）与不需要该手术的组（N0组；n = 16）。将与供体、移植物、受体及手术数据相关的参数与短期和长期结果进行关联分析。两组在受体和供体年龄、性别、HLA相容性及移植前透析时间方面具有同质性。
当不需要进行肾切除术时，手术时间较短（N0组为3.01小时，N+组为4.23小时；P <.001），术中输注的晶体液较少（N0组为1.84升，N+组为2.76升；P <.001），血浆（N0组为2.07单位，N+组为2.93单位；P <.05）或血液（N0组为1.05单位，N+组为1.81单位；P <.05）的输注量也较少。住院时间相似（N0组为12.70天，N+组为16.50天；P无显著性差异[NS]）。肾切除组仅出现1例泌尿系统并发症。移植肾功能延迟恢复率（N0组为19.9%，N+组为12.5%）、急性排斥反应率（N0组为25.5%，N+组为33.3%）、慢性移植物功能障碍率（N0组为15.8%，N+组为28.6%）无差异（P = NS）。1个月以及1年和5年时的移植物功能相当。1年和5年时的患者及移植物存活率相似。移植物丢失或患者死亡原因无差异。
对于ADPKD患者，在移植手术期间可安全地对一侧肿大肾脏进行自体肾切除术，且对住院时间、移植物短期和长期功能及患者存活率无不良影响。然而，该手术会导致手术时间延长，对液体和血液制品的需求增加。
