Crowe A, Cairns H S, Wood S, Rudge C J, Woodhouse C R, Neild G H
Institute of Urology and Nephrology, University College and Middlesex School of Medicine, Middlesex Hospital, London, UK.
Nephrol Dial Transplant. 1998 Aug;13(8):2065-9. doi: 10.1093/ndt/13.8.2065.
Renal allograft outcome, during an 8 year period (1985-1992), has been assessed in 56 renal transplants performed in 55 patients who had end-stage renal failure as a consequence of urological abnormalities. The abnormalities were: primary vesicoureteric reflux (VUR) or renal dysplasia (26 patients); posterior urethral valves (PUV) (15); neuropathic bladders (6); vesico-ureteric tuberculosis (5); bladder exstrophy (3); and prune belly syndrome (1). Six patients had augmented bladders, and eight transplants were performed in seven patients with urinary diversions.
Overall, 1 and 5 year actuarial graft survival was 89 and 66%, with mean creatinine of 154 micromol/l +/- 11 (SE) and 145 +/- 9 respectively. Patients with abnormal bladders or conduits (n = 28) had worse graft function than those with normal bladders (n = 28) although graft survival was not significantly different in the two groups at 1 and 5 years: 93 and 75% with normal bladders vs 86 and 57% with abnormal systems. Symptomatic urinary tract infections were common in the first 3 months after transplantation (63%); fever and systemic symptoms occurred in 39% with normal bladders and 59% with abnormal bladders. Urinary tract infection directly contributed to graft loss in six patients with abnormal bladders, but had no consequences in those with normal bladders.
Abnormal bladders must be assessed urodynamically before transplantation, and after transplantation adequacy of urinary drainage must be re-assessed frequently. Prophylactic antibiotics are now given for the first 6 months and urinary tract infections must be treated promptly. With these measures, good results, similar to those of patients without urological problems, can be obtained.
在1985年至1992年的8年期间，对55例因泌尿系统异常导致终末期肾衰竭的患者进行的56例肾移植的肾移植结果进行了评估。异常情况包括：原发性膀胱输尿管反流（VUR）或肾发育不良（26例患者）；后尿道瓣膜（PUV）（15例）；神经源性膀胱（6例）；膀胱输尿管结核（5例）；膀胱外翻（3例）；以及梅干腹综合征（1例）。6例患者有膀胱扩大术，7例尿流改道患者进行了8次移植。
总体而言，1年和5年的实际移植存活率分别为89%和66%，平均肌酐分别为154微摩尔/升±11（标准误）和145±9。膀胱或管道异常的患者（n = 28）的移植功能比膀胱正常的患者（n = 28）差，尽管两组在1年和5年时的移植存活率没有显著差异：膀胱正常的患者为93%和75%，系统异常的患者为86%和57%。移植后前3个月有症状的尿路感染很常见（63%）；膀胱正常的患者中有39%出现发热和全身症状，膀胱异常的患者中有59%出现。尿路感染直接导致6例膀胱异常患者的移植失败，但对膀胱正常的患者没有影响。
移植前必须对异常膀胱进行尿动力学评估，移植后必须频繁重新评估尿路引流是否充分。现在在头6个月给予预防性抗生素，必须及时治疗尿路感染。采取这些措施，可以获得与没有泌尿系统问题的患者相似的良好结果。
