Brazda E, Ofner D, Riedmann B, Spechtenhauser B, Margreiter R
Department of Transplant Surgery, University of Innsbruck, Austria.
Ann Transplant. 1996;1(2):15-8.
Although various forms of polycystic kidney disease (PKD) account for up to 10% of patients requiring renal replacement therapy and severe complications may arise from these kidneys, no clear indications for pretransplant nephrectomy have been defined so far. A total of 104 renal transplants in three pediatric and 96 adult patients suffering from PKD were analysed retrospectively with regard to patient and graft survival in relation to pretransplant or posttransplant nephrectomy and no nephrectomy. Of these 99 patients, 25 had had either unilateral (19) or bilateral (6) nephrectomy sometime before transplantation and 10 patients between 3 and 81 months after transplantation. All patients received Cyclosporine-based immunosuppression. One-year patient and graft survivals for recipients of a first cadaveric renal graft (n = 91) were 94% and 92%, for recipients of second or third graft (n = 13) 89% and 78%. One- and five-year patient survival rates for patients with or without pretransplant nephrectomy were 100% and 100% vs 92% and 84%, respectively. One- and five-year graft survival rates were 100% and 93% for pretransplant nephrectomy patients vs 89% and 74% for the non-nephrectomy group (p < 0.05). Patients not undergoing nephrectomy sometime after transplantation had the same patient but better five-year graft survival when compared to the posttransplant nephrectomy group (89% vs 52%). In patients with early posttransplant urinary tract infection, which is considered in this analysis as a cyst-related complication, graft survival at one year was 77% but 97% in patients without this complication. From these data it is recommended that polycystic kidneys should be removed before transplantation if cyst-related complications occur repeatedly. Posttransplant nephrectomy can be performed with no mortality and should be carried out whenever clinically indicated.
尽管各种形式的多囊肾病（PKD）占需要肾脏替代治疗患者的比例高达10%，且这些肾脏可能引发严重并发症，但迄今为止，尚未明确界定移植前肾切除术的明确指征。对3例儿科和96例成年多囊肾病患者的104例肾移植进行了回顾性分析，比较了移植前或移植后肾切除术及未行肾切除术患者的患者和移植物存活率。在这99例患者中，25例在移植前的某个时间进行了单侧（19例）或双侧（6例）肾切除术，10例在移植后3至81个月进行了肾切除术。所有患者均接受以环孢素为基础的免疫抑制治疗。首次尸体肾移植受者（n = 91）的1年患者和移植物存活率分别为94%和92%，第二次或第三次移植受者（n = 13）为89%和78%。移植前肾切除术患者和未行肾切除术患者的1年和5年患者存活率分别为100%和100%，以及92%和84%。移植前肾切除术患者的1年和5年移植物存活率分别为100%和93%，未行肾切除术组为89%和74%（p < 0.05）。与移植后肾切除术组相比，移植后未在某个时间进行肾切除术的患者有相同的患者存活率，但5年移植物存活率更高（89%对52%）。在本分析中被视为囊肿相关并发症的移植后早期尿路感染患者中，1年移植物存活率为77%，而无此并发症患者为97%。根据这些数据，建议如果囊肿相关并发症反复发生，应在移植前切除多囊肾。移植后肾切除术可无死亡率进行，且应在临床指征明确时进行。
