Department of Organ Transplantation, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, China; Clinical Immunology Translational Medicine Key Laboratory of Sichuan Province; Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China.
Eur Rev Med Pharmacol Sci. 2022 Apr;26(7):2292-2304. doi: 10.26355/eurrev_202204_28459.
For end-stage renal disease (ESRD), patients receiving kidney transplantation, peritoneal dialysis (PD) and hemodialysis (HD) are both appropriate modes of pre-transplant dialysis. The aim of this review is to assess the impact of pre-transplant PD compared to HD on kidney transplant outcomes in ESRD patients.
A comprehensive search in digital databases, like PubMed, SCOPUS and EMBASE and a manual search were conducted to identify cohort studies comparing the kidney transplant outcomes of both pre-transplant dialysis modalities. The data were subjected to both qualitative and quantitative analysis. A meta-analysis was carried out to calculate the effect estimate for patient survival, graft survival and delayed graft function, death-censored graft survival, acute rejection-free graft survival, graft vessel thrombosis, urological complications, surgical complications, any infections, and onset of diabetes after transplantation. The qualities of the included studies were judged by the New-castle Ottawa scale.
The overall patient survival is shown to be better with patients who underwent pre-transplant PD compared to HD with OR 1.34 95% CI [1.11, 1.61], p = 0.002. Delayed graft function was found to be highly associated with HD compared to PD with OR 0.60 [0.52, 0.70], p<0.0001 with moderate heterogeneity (i2 = 48%). However, no difference was observed in terms of graft survival, complications, infections, and new onset of diabetes mellitus compared to patients undergoing pre-transplant HD.
Within the limitations of the review, it can be concluded that ESRD patients undergoing pre-transplant PD were found to have better patient survival and lower incidence of delayed graft function.
对于终末期肾病（ESRD）患者，接受肾移植、腹膜透析（PD）和血液透析（HD）的患者都是移植前透析的合适方式。本综述的目的是评估与 HD 相比，PD 对 ESRD 患者肾移植结局的影响。
在数字数据库（如 PubMed、SCOPUS 和 EMBASE）中进行全面检索，并进行手动搜索，以确定比较两种移植前透析方式的肾移植结局的队列研究。对数据进行定性和定量分析。进行荟萃分析以计算患者生存、移植物生存和延迟移植物功能、死亡相关移植物生存、无急性排斥反应移植物生存、移植物血管血栓形成、尿外科并发症、手术并发症、任何感染和移植后糖尿病的发生率的效应估计。通过纽卡斯尔-渥太华量表评估纳入研究的质量。
与接受 HD 的患者相比，接受 PD 的患者的总体患者生存率更好，OR 为 1.34 [95%CI：1.11，1.61]，p = 0.002。与 PD 相比，HD 与延迟移植物功能高度相关，OR 为 0.60 [0.52，0.70]，p<0.0001，异质性中等（i2 = 48%）。然而，与接受 HD 相比，在移植物生存率、并发症、感染和新发糖尿病方面没有差异。
在本综述的限制范围内，可以得出结论，与接受 HD 的患者相比，接受 PD 的 ESRD 患者具有更好的患者生存率和更低的延迟移植物功能发生率。
