Asderakis A, Augustine T, Dyer P, Short C, Campbell B, Parrott N R, Johnson R W
Renal Transplant Unit, Manchester Royal Infirmary, UK.
Nephrol Dial Transplant. 1998 Jul;13(7):1799-803. doi: 10.1093/ndt/13.7.1799.
Dialysis can be life-saving for patients with end-stage renal failure. However, not only is it associated with significant morbidity and a greater mortality than transplantation, but it is also expensive. Therefore renal transplantation is generally regarded as the treatment of choice for patients in whom this form of renal replacement therapy is appropriate. Transplantation usually takes place after a variable period of dialytic therapy, but pre-emptive kidney transplantation (PKT) has established itself as an attractive alternative.
1463 consecutive first kidney transplants performed between January 1980 and December 1995 in a single centre were analysed. The 161 patients (11%) transplanted without prior dialysis were compared with the 1302 patients who had been dialysed prior to being transplanted. The pre-emptive group did not differ from the dialysis group in respect of donor age, donor and recipient gender, HLA mismatch, or cold ischaemic time, although there were more live donor transplants within the pre-emptive group.
Delayed graft function occurred more frequently in the dialysis group (25% vs 16%) but more patients experienced an acute rejection episode in the pre-emptive group (67 vs 55%). The actuarial graft survival in the pre-emptive group at 1, 5, and 10 years (84, 76 and 67%) was significantly higher than the respective values in the dialysis group (83, 69, and 56%). Within the live donor recipient cohort the survival advantage for the pre-emptive group was even more striking.
Pre-emptive kidney transplantation not only avoids the risks, cost, and inconvenience of dialysis, but is also associated with better graft survival than transplantation after a period of dialysis, particularly within the live donor cohort.
透析对于终末期肾衰竭患者而言可挽救生命。然而，它不仅会引发严重的发病率，且死亡率高于移植，同时费用高昂。因此，对于适合这种肾脏替代治疗形式的患者，肾移植通常被视为首选治疗方法。移植通常在一段时长不定的透析治疗后进行，但抢先肾移植（PKT）已成为一种颇具吸引力的替代方案。
对1980年1月至1995年12月在单一中心进行的1463例连续首次肾移植进行分析。将161例（11%）未接受过透析而接受移植的患者与1302例移植前接受过透析的患者进行比较。抢先移植组在供体年龄、供体和受体性别、HLA错配或冷缺血时间方面与透析组并无差异，尽管抢先移植组中有更多的活体供肾移植。
透析组延迟移植肾功能的发生率更高（25%对16%），但抢先移植组中有更多患者经历急性排斥反应（67例对55例）。抢先移植组1年、5年和10年的移植肾存活精算率（84%、76%和67%）显著高于透析组的相应值（83%、69%和56%）。在活体供肾受体队列中，抢先移植组的存活优势更为显著。
抢先肾移植不仅避免了透析的风险、成本和不便，而且与透析一段时间后进行移植相比，移植肾存活情况更好，尤其是在活体供肾队列中。
