Division of Nephrology, University Hospital Zürich, Zürich, Switzerland.
Department Transplant Immunology and Nephrology, University Basel Hospital, Basel, Switzerland.
Nephrol Dial Transplant. 2020 Dec 4;35(12):2182-2190. doi: 10.1093/ndt/gfaa037.
Patients returning to dialysis after graft loss have high early morbidity and mortality.
We used data from the Swiss Transplant Cohort Study to describe the current practice and outcomes in Switzerland. All patients who received a renal allograft between May 2008 and December 2014 were included. The patients with graft loss were divided into two groups depending on whether the graft loss occurred within 1 year after transplantation (early graft loss group) or later (late graft loss group). Patients with primary non-function who never gained graft function were excluded.
Seventy-seven out of 1502 patients lost their graft during follow-up, 40 within 1 year after transplantation. Eleven patients died within 30 days after allograft loss. Patient survival was 86, 81 and 74% at 30, 90 and 365 days after graft loss, respectively. About 92% started haemodialysis, 62% with definitive vascular access, which was associated with decreased mortality (hazard ratio = 0.28). At the time of graft loss, most patients were on triple immunosuppressive therapy with significant reduction after nephrectomy. One year after graft loss, 77.5% (31 of 40) of patients in the early and 43.2% (16 out of 37) in the late-loss group had undergone nephrectomy. Three years after graft loss, 36% of the patients with early and 12% with late graft loss received another allograft.
In summary, our data illustrate high mortality, and a high number of allograft nephrectomies and re-transplantations. Patients commencing haemodialysis with a catheter had significantly higher mortality than patients with definitive access. The role of immunosuppression reduction and allograft nephrectomy as interdependent factors for mortality and re-transplantation needs further evaluation.
移植肾失功后重新开始透析的患者具有较高的早期发病率和死亡率。
我们使用瑞士移植队列研究的数据来描述瑞士目前的实践和结局。所有在 2008 年 5 月至 2014 年 12 月期间接受肾移植的患者均纳入研究。根据移植肾失功发生在移植后 1 年内（早期移植肾失功组）还是 1 年后（晚期移植肾失功组），将失功患者分为两组。排除了原发性无功能且从未获得移植肾功能的患者。
在随访期间，1502 例患者中有 77 例移植肾失功，其中 40 例发生在移植后 1 年内。11 例患者在移植肾失功后 30 天内死亡。移植肾失功后 30、90 和 365 天的患者生存率分别为 86%、81%和 74%。约 92%的患者开始接受血液透析，其中 62%的患者采用了永久性血管通路，这与死亡率降低有关（风险比=0.28）。在移植肾失功时，大多数患者接受三联免疫抑制治疗，在肾切除术后显著减少。移植肾失功后 1 年，早期失功组 40 例患者中有 77.5%（31 例）和晚期失功组 37 例患者中有 43.2%（16 例）接受了肾切除术。移植肾失功后 3 年，早期失功组 36%和晚期失功组 12%的患者接受了再次移植。
综上所述，我们的数据表明患者死亡率高，肾移植切除和再次移植的比例高。开始血液透析时使用导管的患者死亡率明显高于使用永久性通路的患者。免疫抑制减少和移植肾切除作为影响死亡率和再次移植的相互依赖因素，需要进一步评估。
