Wilson Rebekah S, Courtney Aisling E, Ko Dicken S C, Maxwell Alexander P, McDaid James
From the Regional Nephrology Unit, Belfast City Hospital, Belfast, Northern Ireland, UK.
Exp Clin Transplant. 2019 Feb;17(1):11-17. doi: 10.6002/ect.2017.0137. Epub 2018 Jan 2.
Lower urinary tract dysfunction can lead to chronic kidney disease, which, despite surgical intervention, will progress to end-stage renal disease, requiring dialysis. Urologic pathology may damage a transplanted kidney, limiting patient and graft survival. Although smaller studies have suggested that urinary tract dysfunction does not affect graft or patient survival, this is not universally accepted. Northern Ireland has historically had the highest incidence of neural tube defects in Europe, giving rich local experience in caring for patients with lower urinary tract dysfunction. Here, we analyzed outcomes of renal transplant recipients with lower urinary tract dysfunction versus control recipients.
We identified 3 groups of kidney transplant recipients treated between 2001 and 2010; those in group 1 had end-stage renal disease due to lower urinary tract dysfunction with prior intervention (urologic surgery, long-term catheter, or intermittent self-catheterization), group 2 had end-stage renal disease secondary to lower urinary tract dysfunction without intervention, and group 3 had end-stage renal disease due to polycystic kidney disease (chosen as a relatively healthy control cohort without comorbid burden of other causes of end-stage renal disease such as diabetes). The primary outcome measured, graft survival, was death censored, with graft loss defined as requirement for renal replacement therapy or retransplant. Secondary outcomes included patient survival and graft function.
In 150 study patients (16 patients in group 1, 64 in group 2, and 70 in group 3), 5-year death-censored graft survival was 93.75%, 90.6%, and 92.9%, respectively, with no significant differences in graft failure among groups (Cox proportional hazards model). Five-year patient survival was 100%, 100%, and 94.3%, respectively.
Individuals with a history of lower urinary tract dysfunction had graft and patient survival rates similar to the control group. When appropriately treated, lower urinary tract dysfunction is not a barrier to successful renal transplant.
下尿路功能障碍可导致慢性肾脏病，即便经过手术干预，仍会进展至终末期肾病，进而需要透析治疗。泌尿系统病理学改变可能损害移植肾，限制患者生存及移植物存活。尽管小型研究提示尿路功能障碍不影响移植物或患者存活，但这一观点尚未得到普遍认可。历史上，北爱尔兰的神经管缺陷发病率在欧洲最高，因而在照料下尿路功能障碍患者方面积累了丰富的本地经验。在此，我们分析了存在下尿路功能障碍的肾移植受者与对照受者的结局。
我们确定了2001年至2010年间接受治疗的3组肾移植受者；第1组患者因下尿路功能障碍导致终末期肾病且此前接受过干预（泌尿外科手术、长期留置导尿管或间歇性自我导尿），第2组患者因下尿路功能障碍继发终末期肾病但未接受干预，第3组患者因多囊肾病导致终末期肾病（选择该组作为相对健康的对照队列，无糖尿病等其他终末期肾病病因的合并症负担）。所测量的主要结局为移植物存活，以死亡作为删失数据，移植物丢失定义为需要肾脏替代治疗或再次移植。次要结局包括患者存活和移植物功能。
在150例研究患者中（第1组16例，第2组64例，第3组70例），5年死亡删失后的移植物存活率分别为93.75%、90.6%和92.9%，各组间移植物失败无显著差异（Cox比例风险模型）。5年患者存活率分别为100%、100%和94.3%。
有下尿路功能障碍病史的个体，其移植物和患者存活率与对照组相似。经过适当治疗后，下尿路功能障碍并非成功进行肾移植的障碍。
