Aytekin Sami, Dinç Bora, Ertuğ Zeki, Hadimioğlu Necmiye, Aytekin Esra Çobankent
Department of Anaesthesiology and Reanimation, Akdeniz University School of Medicine, Antalya, Turkey.
Department of Pathology, Akdeniz University School of Medicine, Antalya, Turkey.
Turk J Anaesthesiol Reanim. 2020 Apr;48(2):102-107. doi: 10.5152/TJAR.2019.34033. Epub 2019 Oct 8.
Preemptive transplantation cannot be performed for all patients because of the limited number of donors. This study aimed to evaluate the perioperative effects of dialysis before renal transplantation.
In this study, we retrospectively investigated 666 patients who underwent kidney transplantation at our centre. We divided patients into two groups: patients with pre-transplant dialysis (67.3%, n=448) and patients with preemptive transplant (32.7%, n=218). We carried out preoperative, intraoperative and postoperative comparisons between groups.
No difference was observed in terms of intraoperative blood transfusion, crystalloid and colloid requirement, inotropic-vasopressor agent administration and hemodynamic parameters between the patients with pre-transplant dialysis and preemptive transplant. It was observed that dialysis requirement, delayed graft function and acute rejection development were significantly higher during the postoperative period in patients who underwent dialysis before transplantation. In patients with non-preemptive transplant, the decrease of serum creatinine levels at the first postoperative month was more prominent when compared to patients with preemptive transplant; however, that difference disappeared in the first year follow-up. No significant difference was found for serum albumin levels and proteinuria alterations of the patients in long-term follow-up. Additionally, patient and graft survival comparisons between patients with non-preemptive and preemptive transplant on three-year follow-up revealed no significant difference.
We think that preemptive transplantation treatment is a better option for patients with end-stage renal failure since patients with preemptive transplantation appear to have less metabolic function impairment, complication risk and more successful outcomes in terms of cost-effectiveness.
由于供体数量有限，无法对所有患者进行抢先移植。本研究旨在评估肾移植前透析的围手术期效果。
在本研究中，我们回顾性调查了在本中心接受肾移植的666例患者。我们将患者分为两组：移植前透析患者（67.3%，n = 448）和抢先移植患者（32.7%，n = 218）。我们对两组患者进行了术前、术中和术后比较。
移植前透析患者和抢先移植患者在术中输血、晶体液和胶体液需求量、血管活性药物使用及血流动力学参数方面未观察到差异。观察到移植前接受透析的患者术后透析需求、移植肾功能延迟恢复和急性排斥反应的发生率显著更高。在非抢先移植患者中，术后第一个月血清肌酐水平的下降比抢先移植患者更显著；然而，在第一年随访中这种差异消失。在长期随访中，患者血清白蛋白水平和蛋白尿改变无显著差异。此外，在三年随访中，非抢先移植患者和抢先移植患者的患者及移植物生存率比较未发现显著差异。
我们认为，对于终末期肾衰竭患者，抢先移植治疗是更好的选择，因为抢先移植患者似乎代谢功能损害更小、并发症风险更低，且在成本效益方面有更成功的结果。
