Yang Q, Zhao S, Chen W, Mao H, Huang F, Zheng Z, Chen L, Fei J, Yu X
Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, PR China.
Clin Nephrol. 2009 Jul;72(1):62-8. doi: 10.5414/cnp72062.
The present study investigated the influence of the pretransplant dialysis modality, hemodialysis (HD) or peritoneal dialysis (PD), on renal transplant complications and outcomes.
402 cadaveric renal transplant patients maintained on HD (N = 303) or PD (N = 99) for more than 3 months prior to transplantation were studied retrospectively, and a total of 345 patients were followed up for 30.2 +/- 15.2 months. The impact of HD or PD on acute rejection, delayed graft function (DGF), infection, chronic rejection, and the survival rate of graft and patients were analyzed.
There was no significant difference between the HD and PD groups with regard to the causes of end-stage renal disease, age, gender, blood pressure, hemoglobin, HLA match, hot and cold ischemia time, and hepatitis C virus infection. The incidence rates of DGF, acute rejection, chronic rejection and cytomegalovirus and other infections were also not significantly different between the HD and PD groups. However, compared to HD, patients with PD had longer dialysis duration (p < 0.05), but less hepatitis B infection (p < 0.05) and post-transplant infection (p < 0.05). In contrast, in those PD patients with hepatitis B infection, graft loss was significantly increased (19.23% vs. 8.86% , p = 0.021). The incidence of acute rejection episodes was higher in HD patients who had pretransplant dialysis for more than 12 months (p < 0.05). The overall patient and graft survival rates within 5 years between the HD and PD groups were not significantly different (p > 0.05).
The influence of PD and HD on complications after renal transplant at 1 year and 5 years and graft survival rates was similar, and therefore, either HD or PD can be chosen as the pretransplant dialysis modality. However, patients in the PD group had a reduced incidence of hepatitis virus infection, suggesting that PD may have certain advantages over HD as a preoperative substitution therapy for renal transplantation.
本研究调查了移植前透析方式，即血液透析（HD）或腹膜透析（PD），对肾移植并发症及预后的影响。
对402例在移植前接受HD（n = 303）或PD（n = 99）维持治疗超过3个月的尸体肾移植患者进行回顾性研究，共345例患者接受了30.2±15.2个月的随访。分析HD或PD对急性排斥反应、移植肾功能延迟恢复（DGF）、感染、慢性排斥反应以及移植肾和患者生存率的影响。
HD组和PD组在终末期肾病病因、年龄、性别、血压、血红蛋白、HLA配型、冷热缺血时间以及丙型肝炎病毒感染方面无显著差异。HD组和PD组的DGF、急性排斥反应、慢性排斥反应以及巨细胞病毒和其他感染的发生率也无显著差异。然而，与HD相比，PD患者的透析时间更长（p < 0.05），但乙肝感染（p < 0.05）和移植后感染（p < 0.05）较少。相反，在那些乙肝感染的PD患者中，移植肾丢失显著增加（19.23%对8.86%，p = 0.021）。移植前透析超过12个月的HD患者急性排斥反应发生率更高（p < 0.05）。HD组和PD组5年内的总体患者和移植肾生存率无显著差异（p > 0.05）。
PD和HD对肾移植后1年和5年并发症及移植肾生存率的影响相似，因此，HD或PD均可作为移植前透析方式。然而，PD组患者的肝炎病毒感染发生率较低，提示PD作为肾移植术前替代治疗可能比HD具有一定优势。
