Joo K W, Shin S J, Lee S H, Ha J W, Kim S, Kim Y S
Seoul National University College of Medicine, Seoul, South Korea.
Transplant Proc. 2007 Dec;39(10):3061-4. doi: 10.1016/j.transproceed.2007.07.091.
Although preemptive transplantation of kidneys from living donors without the previous initiation of dialysis is associated with longer allograft survival in a USRDS cohort, the effect of pretransplantation dialysis on graft outcome is still controversial in Korea. The purpose of this study was to evaluate the differential effects on long-term outcomes of living donor kidney transplantation according to initiation of dialysis and its duration or no dialysis. We performed a retrospective cohort study of 494 patients who received a first kidney transplant from a living donor between 1990 and 2006. The mean duration for dialysis was 14.5+/-22.2 months. The 10-year patient survival of 98.0% in the preemptive group was not significantly higher than the dialysis group (91.2%, P>.05). However, 10-year graft survival was higher in the preemptive than the dialysis group (preemptive 94.4%, dialysis 76.5%; P<.05). The differential effect of pretransplant dialysis either by hemodialysis or peritoneal dialysis was not significant, although peritoneal dialysis as a pretransplant treatment seemed to be beneficial on long-term graft survival (5-year graft survival; peritoneal 94.8% and hemodialysis 89.2%). The duration of dialysis did not affect graft survival in our study cohort. In conclusion, we suggest that preemptive transplantation should be applied to eligible patients.
尽管在美国肾脏数据系统（USRDS）队列中，未预先开始透析的活体供肾抢先移植与同种异体肾移植的更长存活时间相关，但在韩国，移植前透析对移植结果的影响仍存在争议。本研究的目的是根据透析的开始情况及其持续时间或未透析情况，评估其对活体供肾移植长期结果的不同影响。我们对1990年至2006年间接受首次活体供肾移植的494例患者进行了一项回顾性队列研究。透析的平均持续时间为14.5±22.2个月。抢先移植组10年患者生存率为98.0%，并不显著高于透析组（91.2%，P>0.05）。然而，抢先移植组的10年移植肾生存率高于透析组（抢先移植组94.4%，透析组76.5%；P<0.05）。尽管移植前进行腹膜透析似乎对长期移植肾存活有益（5年移植肾生存率；腹膜透析94.8%，血液透析89.2%），但血液透析或腹膜透析的移植前透析差异效应并不显著。在我们的研究队列中，透析持续时间并未影响移植肾存活。总之，我们建议应将抢先移植应用于符合条件的患者。
