CAJ | 학술논문

目的探讨血液透析(HD)与腹膜透析(PD)对肾移植术后并发症和预后的影响.方法回顾分析402例术前维持性透析超过3个月的同种异体尸体肾移植术患者的临床资料.按透析方式将患者分为HD组(303例)和PD组(99例),并对345例随访(30.2±15.2)月.比较术前HD和PD对肾移植术后受者和移植肾存活率以及肾移植术后并发症,包括急性排斥、移植肾功能延迟恢复(DGF)、感染、慢性排斥等的影响.结果除了术前平均透析时间PD组长于HD组,乙型肝炎(乙肝)感染率HD组明显高于PD组外,在原发病、年龄、性别、血压、血红蛋白、HLA配型、冷热缺血时间、丙型肝炎感染等方面两组间差异无统计学意义.移植术后两组在DGF、急性排斥、慢性排斥、巨细胞病毒(CMV)感染和其他感染的发生率等方面差异无统计学意义.HD组术前透析时间12个月的患者急性排斥的发生率显著高于<12个月的患者(P<0.05).乙肝患者比非乙肝患者更易发生移植肾丧失功能(19.23%比8.86%,P=0.021).PD组乙肝病毒阴性的患者术后感染发生率较低.术后患者1年和5年存活率在两组间差异无统计学意义(1年:HD 94.34%,PD 91.25%;5年:HD 92.83%,PD90%);同样移植肾1年和5年存活率两组间差异也无统计学意义(1年:HD 93.21%,PD96.25%;5年:HD 87.17%,PD 91.25%).结论 HD和PD对肾移植术后并发症、患者及移植肾1年和5年存活率的影响相似,均可作为慢性肾衰竭患者肾移植术前替代治疗.HD患者的急性排斥发生率随着透析时间的延长而增加,因此,缩短肾移植前透析时间将有助减少肾移植术后并发症.
목적 탐토혈액투석(HD)여복막투석(PD)대신이식술후병발증화예후적영향.방법 회고분석402례술전유지성투석초과3개월적동충이체시체신이식술환자적림상자료.안투석방식장환자분위HD조(303례)화PD조(99례),병대345례수방(30.2±15.2)월.비교술전HD화PD대신이식술후수자화이식신존활솔이급신이식술후병발증,포괄급성배척、이식신공능연지회복(DGF)、감염、만성배척등적영향.결과 제료술전평균투석시간PD조장우HD조,을형간염(을간)감염솔HD조명현고우PD조외,재원발병、년령、성별、혈압、혈홍단백、HLA배형、랭열결혈시간、병형간염감염등방면량조간차이무통계학의의.이식술후량조재DGF、급성배척、만성배척、거세포병독(CMV)감염화기타감염적발생솔등방면차이무통계학의의.HD조술전투석시간12개월적환자급성배척적발생솔현저고우<12개월적환자(P<0.05).을간환자비비을간환자경역발생이식신상실공능(19.23%비8.86%,P=0.021).PD조을간병독음성적환자술후감염발생솔교저.술후환자1년화5년존활솔재량조간차이무통계학의의(1년:HD 94.34%,PD 91.25%;5년:HD 92.83%,PD90%);동양이식신1년화5년존활솔량조간차이야무통계학의의(1년:HD 93.21%,PD96.25%;5년:HD 87.17%,PD 91.25%).결론 HD화PD대신이식술후병발증、환자급이식신1년화5년존활솔적영향상사,균가작위만성신쇠갈환자신이식술전체대치료.HD환자적급성배척발생솔수착투석시간적연장이증가,인차,축단신이식전투석시간장유조감소신이식술후병발증.
Objective To investigate the effects of hemodialysis (HD) and peritoneal dialysis (PD) on the complications and outcomes after renal transplantation. Methods Clinical data of 402 renal transplant recipients maintained on dialysis for more than 3 months were retrospectively studied and divided into 2 groups: HD group(n=303)and PD group(n=99). Among them, 345 recipients were followed up for an average of (30.2±15.2) months. The impact of HD and PD on the acute rejection, delayed graft function (DGF), infection, chronic rejection and the graft and patient survival rates were analyzed. Results The mean dialysis duration was significantly longer in PD group and the hepatitis B infection rate was significantly higher in HD group. There were no signiticant differences between the HD and PD groups in regarding to primary disease for end-stage renal disease, age, gender, blood pressure, hemoglobin, HLA match, hot and cold ischemia time, and hepatitis C vires infection. The incidence of DGF, acute and chronic rejection, and cytomegalovirus and other infections between HD and PD groups were not significantly different. However, the graft loss happened more frequently in hepatatis B patients than that in non hepatitis B patients (19.23% vs 8.86%, P=0.021), and the post-transplant infection ocurred less in non hepatits B patients with PD. The acute rejection episodes were higher in HD patients who received pretransplant dialysis for more than 12 months (P<0.05). The overall recipients survival rates of HD and PD groups were similar (1-year: HD 94.34%, PD 91.25%;5-year: HD 92.83%, PD 90%), and the same as the graft survival rates in HD and PD groups (1-year: HD 93.21%, PD 96.25%;5-year: HD 87.17%, PD 91.25%). Conclusions The influences of PD and HD on the complications after renal transplantaton, 1-year and S-year recipients and graft survival rates are similar, so both HD and PD can be chosen as the pretransplant dialysis modality. As the incidence of acute rejection increases with time in HD, it is better to shorten the time of pretransplant dialysis to decrease the complication.