Department of Medicine III, Medical University of Vienna, Vienna, Austria.
Transplantation. 2009 Dec 27;88(12):1377-85. doi: 10.1097/TP.0b013e3181bc03ab.
Hemodialysis immediately before kidney transplant surgery has been suggested to adversely affect early graft function. On the other hand, considering its profound antiinflammatory effects, a beneficial impact of regional citrate anticoagulation on the evolution of graft function can be speculated. We sought to assess the clinical impact of preoperative hemodialysis and dialysis anticoagulation in two related randomized trials.
Eligible kidney transplant candidates with a serum potassium less than or equal to 5.0 mEq/L were randomized to receive dialysis or no dialysis before deceased donor transplantation. Patients with a potassium more than 5.0 mEq/L were randomized to receive dialysis with heparin or citrate anticoagulation. The primary endpoint was the estimated glomerular filtration rate (eGFR) at posttransplant day 5.
The first comparison (56 vs. 54 patients) revealed no effect of dialysis on eGFR at day 5 (primary endpoint, 12 [interquartile range 5-36] vs. 13 [5-37] mL/min/1.73 m2, P=0.98), rates of delayed graft function (22% vs. 27%, P=0.66), cellular rejection (20% vs. 24%, P=0.65), and C4d-positive dysfunction (2% vs. 9%, P=0.11) or 1-year death-censored graft survival (89% vs. 91%, P=0.51). Comparing citrate with heparin anticoagulation (44 vs. 66 patients), no differences in eGFR at day 5 (17 [8-31] vs. 14 [6-38] ml/min/1.73 m2, P=0.57), delayed graft function (21% vs. 30%, P=0.28), cellular rejection (23% vs. 33%, P=0.29), and graft survival (90% vs. 88%, P=0.44) were found. For citrate anticoagulation, less C4d-positive rejection episodes (P=0.08) and higher 1-year eGFR levels (P=0.03) were observed.
Pretransplant hemodialysis and anticoagulation may not affect early graft function in a meaningful way.
在肾移植手术前进行血液透析被认为会对早期移植物功能产生不利影响。另一方面，考虑到其强大的抗炎作用，可以推测局部枸橼酸抗凝对移植物功能的演变有有益的影响。我们试图在两项相关的随机试验中评估术前血液透析和透析抗凝的临床影响。
符合条件的血清钾小于或等于 5.0 mEq/L 的肾移植候选者被随机分为接受或不接受死亡供体移植前的透析。血清钾大于 5.0 mEq/L 的患者被随机分为肝素或枸橼酸抗凝透析。主要终点是移植后第 5 天的估计肾小球滤过率（eGFR）。
第一次比较（56 例与 54 例患者）显示透析对第 5 天的 eGFR 没有影响（主要终点，12[四分位距 5-36] vs. 13[5-37]mL/min/1.73m2，P=0.98），移植物功能延迟（22% vs. 27%，P=0.66）、细胞排斥（20% vs. 24%，P=0.65）、C4d 阳性功能障碍（2% vs. 9%，P=0.11）或 1 年死亡无复发生存率（89% vs. 91%，P=0.51）。比较枸橼酸与肝素抗凝（44 例与 66 例患者），第 5 天 eGFR 无差异（17[8-31] vs. 14[6-38]mL/min/1.73m2，P=0.57），移植物功能延迟（21% vs. 30%，P=0.28），细胞排斥（23% vs. 33%，P=0.29）和移植物存活率（90% vs. 88%，P=0.44）。对于枸橼酸抗凝，观察到较少的 C4d 阳性排斥事件（P=0.08）和较高的 1 年 eGFR 水平（P=0.03）。
移植前血液透析和抗凝可能不会以有意义的方式影响早期移植物功能。
