Department of Nephrology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia.
Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China.
PLoS One. 2023 Jul 18;18(7):e0284152. doi: 10.1371/journal.pone.0284152. eCollection 2023.
The result of published studies on the clinical outcome of peritoneal dialysis (PD) after kidney allograft failure is conflicting. There are also few published data on the outcome of patients who had PD before kidney transplant and then return to PD after allograft failure.
We reviewed 100 patients who were started on PD after kidney allograft failure between 2001 and 2020 (failed transplant group); 50 of them received PD before transplant. We compared the clinical outcome to 200 new PD patients matched for age, sex, and diabetic status (control group).
The patients were followed for 45.8 ± 40.5 months. the 2-year patient survival rate was 83.3% and 87.8% for the failed transplant and control groups, respectively (log rank test, p = 0.2). The corresponding 2-year technique survival rate 66.5% and 71.7% (p = 0.5). The failed transplant and control groups also had similar hospitalization rate and peritonitis rate. In the failed transplant group, there was also no difference in patient survival, technique survival, hospitalization, or peritonitis rate between those with and without PD before transplant. In the failed transplant group, patients who had PD before transplant and then returned to PD after allograft failure had substantial increase in D/P4 (0.585 ± 0.130 to 0.659 ± 0.111, paired t-test, p = 0.032) and MTAC creatinine (7.74 ± 3.68 to 9.73 ± 3.00 ml/min/1.73m2, p = 0.047) from the time before the transplant to the time after PD was resumed after failed allograft.
The clinical outcome of PD patients with a failed kidney allograft is similar to other PD patients. However, patients who have a history of PD before kidney transplant and then return to PD after allograft failure have increased peritoneal transport parameters.
关于肾移植失败后腹膜透析（PD）临床结局的已发表研究结果存在矛盾。关于在肾移植前接受 PD 治疗，随后在移植肾失功后再次转为 PD 的患者结局的数据也很少。
我们回顾了 2001 年至 2020 年间 100 例肾移植失败后开始接受 PD 治疗的患者（移植失败组）；其中 50 例患者在移植前接受过 PD。我们将他们的临床结局与 200 例年龄、性别和糖尿病状态匹配的新 PD 患者（对照组）进行了比较。
患者的中位随访时间为 45.8 ± 40.5 个月。移植失败组和对照组的 2 年患者生存率分别为 83.3%和 87.8%（对数秩检验，p = 0.2）。相应的 2 年技术生存率分别为 66.5%和 71.7%（p = 0.5）。移植失败组和对照组的住院率和腹膜炎发生率也相似。在移植失败组中，在移植前接受过 PD 治疗和未接受 PD 治疗的患者之间，患者生存率、技术生存率、住院率和腹膜炎发生率也无差异。在移植失败组中，在移植肾失功后再次转为 PD 的患者中，D/P4（0.585 ± 0.130 至 0.659 ± 0.111，配对 t 检验，p = 0.032）和 MTAC 肌酐（7.74 ± 3.68 至 9.73 ± 3.00 ml/min/1.73m2，p = 0.047）从移植前到再次转为 PD 时均显著增加。
移植肾失功后接受 PD 治疗的患者的临床结局与其他 PD 患者相似。然而，在肾移植前有 PD 治疗史，随后在移植肾失功后再次转为 PD 的患者的腹膜转运参数增加。
