Freitas C, Fructuoso M, Martins L S, Almeida M, Pedroso S, Dias L, Henriques A C, Cabrita A
Department of Nephrology, Santo António Hospital, Porto, Portugal.
Transplant Proc. 2011 Jan-Feb;43(1):113-6. doi: 10.1016/j.transproceed.2010.12.008.
The impact of dialysis modality on posttransplant outcomes remains controversial. The authors have compared primary failure, delayed graft function (DGF), acute rejection episodes as well as patient and allograft survivals among patients undergoing renal transplantation between 2004 and 2009, according to the modality of hemodialysis (HD) versus peritoneal dialysis (PD). We studied 306 patients (268 HD and 38 PD) with a mean follow-up of 29 ± 16 months. The PD cohort included a predominance of females (68.4% vs 36.2%; P = .001), lower age at transplantation (38 ± 14 vs 46 ± 12 years; P = .004), shorter time on dialysis (33 ± 49 vs 59 ± 157 months; P = .043), and higher rate of living donor grafts (PD 31.6% vs HD 13.1%; P = .003). Donor age (PD 43 ± 13 vs HD 45 ± 14 years; P = .30), human leukocyte antigen mismatch (P = .17), panel reactive antibody values (HD 11 ± 22 vs PD 13 ± 26; P = .55), and hyperimmunized patients (HD 3.73%; PD 7.89%; P = .23) were not different. Primary graft failure (3.4% vs 0%; P = .025) and DGF (37.1% vs 13.1%; P = .037) were more frequent among HD patients, but incidences of acute rejection episodes were similar (HD 10.5% vs PD 5.3%; P = 0.19). Neither recipient survival at 1 (97% in PD and HD) or 3 years (HD 90% vs PD 94%; P = .657) nor allograft survival at 1 year (HD 94% vs PD 95%; P = .80) or 3 years: (HD 70%, vs PD 81%; P = .73) were different. Graft function was similar at 1 (HD 64.2 ± 25 vs PD 56.4 ± 24 mL/min; P = .17) and 3 years (HD 62.3 ± 21 vs PD 46 ± 23 mL/min; P = .16). In our study, HD patients showed an higher incidence of DGF and primary allograft failure, but there was no difference in acute rejection episodes, long-term survivals, or renal function.
透析方式对移植后结局的影响仍存在争议。作者比较了2004年至2009年间接受肾移植患者的原发性移植失败、移植肾功能延迟恢复（DGF）、急性排斥反应发生率以及患者和移植肾存活率，比较了血液透析（HD）与腹膜透析（PD）两种方式。我们研究了306例患者（268例HD患者和38例PD患者），平均随访时间为29±16个月。PD组女性占比更高（68.4%对36.2%；P = 0.001），移植时年龄更低（38±14岁对46±12岁；P = 0.004），透析时间更短（33±49个月对59±157个月；P = 0.043），活体供肾移植比例更高（PD组为31.6%，HD组为13.1%；P = 0.003）。供体年龄（PD组43±13岁，HD组45±14岁；P = 0.30）、人类白细胞抗原错配情况（P = 0.17）、群体反应性抗体值（HD组11±22，PD组13±26；P = 0.55）以及高度致敏患者（HD组3.73%，PD组7.89%；P = 0.23）无差异。HD患者原发性移植失败（3.4%对0%；P = 0.025）和移植肾功能延迟恢复（37.1%对13.1%；P = 0.037）更为常见，但急性排斥反应发生率相似（HD组10.5%，PD组5.3%；P = 0.19）。1年时（PD组和HD组均为97%）或3年时受者生存率（HD组90%，PD组94%；P = 0.657）以及1年时（HD组94%，PD组95%；P = 0.80）或3年时移植肾存活率（HD组70%，PD组81%；P = 0.73）均无差异。1年时（HD组64.2±25，PD组56.4±24 mL/min；P = 0.17）和3年时移植肾功能相似（HD组62.3±21，PD组46±23 mL/min；P = 0.16）。在我们的研究中，HD患者移植肾功能延迟恢复和原发性移植肾失败的发生率更高，但急性排斥反应发生率、长期生存率或肾功能无差异。
