胰肾联合移植：透析方式对结局的影响。

Pancreas-Kidney transplantation: Impact of dialysis modality on the outcome.

作者信息

Martins La Salete, Malheiro Jorge, Pedroso Sofia, Almeida Manuela, Dias Leonidio, Henriques António C, Silva Donzília, Davide José, Cabrita António, Noronha Irene L, Rodrigues Anabela

机构信息

Nephrology Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal.

Unit for Multidisciplinary Research in Biomedicine, Institute of Biomedical Sciences Abel Salazar and University Hospital de Santo António, University of Porto, Porto, Portugal.

出版信息

Transpl Int. 2015 Aug;28(8):972-9. doi: 10.1111/tri.12565. Epub 2015 Apr 8.

DOI:10.1111/tri.12565

PMID:25790131

Abstract

It remains controversial whether dialysis modality prior to SPKT (simultaneous pancreas-kidney transplantation) affects the outcome. We analyzed outcomes in type 1 diabetic patients undergoing SPKT, comparing peritoneal dialysis (PD) and hemodialysis (HD) groups: 119 had been on HD; 39 on PD. They were comparable except regarding dialysis time, higher in HD patients (30 ± 23 vs. 21 ± 15 months, P = 0.003). Thrombosis-driven relaparotomy was more frequent in PD patients (12.8% vs. 1.7%, P = 0.014). Pancreas loss due to infection was higher in PD patients (12.8% vs. 3.4%, P = 0.042). Thrombosis-related kidney loss was more frequent in PD patients (5.1%, vs. 0% in HD patients, P = 0.058). Thirteen deaths occurred, more within the PD group (17.9% vs. 5%; P = 0.011), being infection the leading cause (13.5%, vs. 1.7% in HD patients, P = 0.010). Patient survival was inferior in PD patients. Besides PD, cardiovascular disease and graft failure were independent predictors of patient death. In conclusion, PD patients more frequently complicated with intra-abominal infection leading to pancreatic loss and with renal thrombosis, with adverse impact on survival. As a PD first strategy in end-stage renal disease patients is generally associated with good outcomes, these gloomier results after SPKT urge for careful adjustment of infection and thrombosis prophylactic protocols in PD patients.

摘要

在胰肾联合移植（SPKT）之前采用的透析方式是否会影响治疗结果仍存在争议。我们分析了接受SPKT的1型糖尿病患者的治疗结果，比较了腹膜透析（PD）组和血液透析（HD）组：119例接受血液透析，39例接受腹膜透析。除透析时间外，两组具有可比性，血液透析患者的透析时间更长（30±23个月 vs. 21±15个月，P = 0.003）。因血栓形成而进行再次剖腹手术在腹膜透析患者中更为常见（12.8% vs. 1.7%，P = 0.014）。因感染导致的胰腺丢失在腹膜透析患者中更高（12.8% vs. 3.4%，P = 0.042）。与血栓形成相关的肾脏丢失在腹膜透析患者中更常见（5.1%，血液透析患者为0%，P = 0.058）。共发生13例死亡，腹膜透析组更多（17.9% vs. 5%；P = 0.011），感染是主要死因（13.5%，血液透析患者为1.7%，P = 0.010）。腹膜透析患者的生存情况较差。除腹膜透析外，心血管疾病和移植物功能衰竭是患者死亡的独立预测因素。总之，腹膜透析患者更常并发腹腔内感染导致胰腺丢失和肾血栓形成，对生存产生不利影响。由于终末期肾病患者采用腹膜透析优先策略通常会有良好的治疗结果，胰肾联合移植后这些更严峻的结果促使我们仔细调整腹膜透析患者的感染和血栓预防方案。