单队列研究：ABO 血型不合的肾移植受者发生淋巴囊肿的风险更高。
Single cohort study: ABO-incompatible kidney transplant recipients have a higher risk of lymphocele formation.
机构信息
Department of General and Digestive Surgery, Section of Transplant Surgery, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany.
Department of Medicine IV, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany.
出版信息
Langenbecks Arch Surg. 2019 Dec;404(8):999-1007. doi: 10.1007/s00423-019-01812-y. Epub 2019 Aug 27.
PURPOSE
Since 2004, ABO-incompatible kidney transplantation (ABOi KTx) became an established procedure to expand the living donor pool in Germany. Currently, ABOi KTx comprises > 20% of all living donor KTx. Up to September 2015, > 100 ABOi KTx were performed in Freiburg. Regarding lymphocele formation, only scarce data exist.
METHODS
Between April 2004 and September 2015, 106 consecutive ABOi and 277 consecutive ABO-compatible kidney transplantations (ABOc KTx) were performed. Two ABOi and 117 ABOc recipients were excluded due to differences in immunosuppression. One hundred-four ABOi and 160 ABOc KTx patients were analyzed concerning lymphocele formation.
RESULTS
The incidence of lymphoceles in ABOi KTx was 25.2% and 10.6% in ABOc KTx (p = 0.003). A major risk factor appeared the frequency of ≥ 8 preoperative immunoadsorption and/or plasmapheresis sessions (OR 5.61, 95% CI 2.31-13.61, p < 0.001). Particularly, these ABOi KTx recipients had a distinctly higher risk of developing lymphocele (40.0% vs. 19.2%, p = 0.044). IA/PE sessions on day of transplantation (no lymphocele 20.0% vs. lymphocele 28.6%, p = 0.362) or postoperative IA/PE sessions (no lymphocele 25.7% vs. lymphocele 24.1%, p = 1.0) showed no influence on formation of lymphoceles.
CONCLUSION
In ABOi KTx, the incidence of lymphocele formation is significantly increased compared to ABOc KTx and leads to more frequent surgical reinterventions without having an impact on graft survival.
目的
自 2004 年以来，ABO 不相容的肾移植（ABOi KTx）已成为德国扩大活体供者库的一种既定方法。目前，ABOi KTx 占所有活体供肾移植的>20%。截至 2015 年 9 月，弗莱堡共进行了>100 例 ABOi KTx。关于淋巴囊肿的形成，仅有少量数据。
方法
2004 年 4 月至 2015 年 9 月，连续进行了 106 例 ABOi 和 277 例 ABO 相容的肾移植（ABOc KTx）。由于免疫抑制的差异，排除了 2 例 ABOi 和 117 例 ABOc 受者。对 104 例 ABOi 和 160 例 ABOc KTx 患者的淋巴囊肿形成情况进行了分析。
结果
ABOi KTx 淋巴囊肿的发生率为 25.2%，ABOc KTx 为 10.6%（p=0.003）。一个主要的危险因素是术前免疫吸附和/或血浆置换的频率≥8 次（OR 5.61，95%CI 2.31-13.61，p<0.001）。特别是，这些 ABOi KTx 受者发生淋巴囊肿的风险明显更高（40.0% vs. 19.2%，p=0.044）。移植当天的 IA/PE 治疗（无淋巴囊肿为 20.0% vs. 淋巴囊肿为 28.6%，p=0.362）或术后 IA/PE 治疗（无淋巴囊肿为 25.7% vs. 淋巴囊肿为 24.1%，p=1.0）对淋巴囊肿的形成没有影响。
结论
与 ABOc KTx 相比，ABOi KTx 中淋巴囊肿形成的发生率显著增加，导致更频繁的手术再干预，但对移植物存活率没有影响。
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