Department of General-, Visceral-, Transplant-Surgery, University of Munich, Germany.
Transplant Center, University of Munich, Germany.
Surgeon. 2019 Apr;17(2):63-72. doi: 10.1016/j.surge.2018.04.005. Epub 2018 May 31.
Surgical complications following kidney transplantation compromise immediate graft survival. However, the role of early surgical complications in the impairment of long-term survival is not completely established due to various other influences, such as patient comorbidities. The purpose of this study was to characterize the impact of surgical complications and overlapping patient comorbidities on graft function and survival after living donor kidney transplantation (LDKT).
Two groups of patients following LDKT between 1995 and 2014 with (n = 65) or without (n = 294) Clavien-Dindo grade 3 and 4 complications were analyzed. Type of surgical revision, graft and patient survival, general patient characteristics, pre-transplant renal function, immunosuppression, and immunological characteristics (HLA mismatch, panel-reactive antibodies, rejections) were determined. Post-transplant graft function as well as long-term graft and patient survival were quantified.
Graft survival was 84.4/97.6% (1y), 75.2/92.7% (3y), and 62.1/87.6% (5y) with/without surgical revision, patient survival was 95.3/99.3%, 90.0/97.5%, and 84.7/93.7%, respectively. Surgical revision was required in 18%, which affected graft survival (p = 0.008) to a comparable extent as pre-existing cardiopulmonary/-vascular disease. Initially impaired graft function recovered to an equal level without complications following surgical revision. Whereas pre-existing cardiopulmonary/-vascular disease affected graft loss and patient survival, surgical revision had no particular impact on patient survival. These observations were confirmed by Cox regression.
Long-term graft survival following LDKT is independently impaired by both postoperative complications and cardiovascular comorbidities. Although both factors may interact, a complication-free postsurgical course may improve graft survival, thereby reducing the need for dialysis restart and enhancing long-term recipient survival.
肾移植术后的手术并发症会影响移植物的即刻存活率。然而，由于患者合并症等各种其他因素的影响，早期手术并发症对长期存活率的影响尚未完全确定。本研究的目的是描述手术并发症和重叠的患者合并症对活体供肾移植（LDKT）后移植物功能和存活的影响。
分析了 1995 年至 2014 年间接受 LDKT 的两组患者，一组（n=65）有 Clavien-Dindo 分级 3 和 4 级并发症，另一组（n=294）无此类并发症。确定了手术修正的类型、移植物和患者的存活率、一般患者特征、移植前肾功能、免疫抑制和免疫特征（HLA 错配、反应性抗体、排斥反应）。评估了移植后移植物功能以及长期移植物和患者存活率。
有/无手术修正的移植物存活率分别为 84.4%/97.6%（1 年）、75.2%/92.7%（3 年）和 62.1%/87.6%（5 年），患者存活率分别为 95.3%/99.3%、90.0%/97.5%和 84.7%/93.7%。18%的患者需要手术修正，这对移植物存活率有影响（p=0.008），与术前心肺血管疾病的影响相当。术后无并发症时，初始受损的移植物功能可恢复到相同水平。虽然术前心肺血管疾病影响移植物丢失和患者存活率，但手术修正对患者存活率没有特殊影响。Cox 回归也证实了这些观察结果。
LDKT 后长期移植物存活率受到术后并发症和心血管合并症的独立影响。尽管这两个因素可能相互作用，但无并发症的术后过程可能会改善移植物存活率，从而减少重新开始透析的需求，并提高长期受者存活率。
