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未经过透析的抢先肾移植对受者有利  

2009-01-30 22:58:51|  分类: 移植研究 |  标签: |举报 |字号 订阅

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活体供肾的抢先移植(Preemptive living donor kidney transplantation,PLDKT)有利于受者和移植物的存活,尚无明确证据表明死亡供者的抢先肾移植(preemptive deceased donor kidney transplantation,PDDKT)是否具有同样的优越性。这项研究比较了术前透析与否对肾移植效果的影响。这个肾移植中心在1999至2004年间共进行了420例肾移植,其中包括了33例的PDDKT。77.5%为男性,年龄48±14岁,49%为无心跳供者,27%为经抢救后心跳停止者,24%为死亡的幼儿。受者术前肌酐6.9±1.8 mg/dL,肌酐清除率14.6±3.6 mL/min。实施抢先肾移植术后结果显示,与透析后肾移植患者相比,二者移植肾延迟恢复发生率分别为0% 和 25%,二组间一个月和一年内的的肌酐水平无显著差异,术后急性排斥反应发生率和1-2年的移植物及受者存活率无差异。因此,PDDKT可以作为慢性肾功能衰竭患者的治疗选择,与透析后才进行肾移植的受者相比,延迟恢复发生率低,二年内的移植物和受者存活率相似,并发症少。

原文摘要

 Transplantation Proceedings, 39, 2123–2124 (2007)

Preemptive Kidney Transplant From Deceased Donors: An Advantage in Relation to Reduced Waiting List

ABSTRACT

Background. Preemptive living donor kidney transplantation is associated with better allograft and recipient survival. However, it remains unclear whether preemptive transplantation from deceased donors is beneficial too. An increased number of deceased donors has reduced the waiting list in our hospital in the last years allowing preemptive deceased donor kidney transplantation (PDDKT). Aim. We compared our experience with preemptive transplantation with patients who underwent dialysis before transplantation. Patients and Methods. Thirty-three PDDKT, including 77.5% male patients of overall mean age of 48±14 years, were performed in our hospital between January 1999 and December 2004 (8% of transplantations). We compared the outcomes of these patients with those of renal transplants in subjects who had undergone dialysis. The donors for both groups had similar characteristic; they were paired donor kidneys in most cases. Results. The types of donors in both groups were: non–heart-beating (49%), heartbeating deceased (27%) or en bloc pediatric (24%). The serum creatinine of the recipients was 6.9±1.8 mg/dL prior to transplantation, and the creatinine clearance was 14.6±3.6 mL/min (estimated by the Cockroft-Gault formula). The Charlson comorbidity index adapted for patients with advanced chronic kidney disease (ACKD) was 0.8±0.2 in the preemptive group versus 1.7±0.4 in the dialysis group (P< .05). Delayed graft function rates were 0% versus 25% in preemptive vs dialysis groups, respectively. No differences in 1-month or 1-year renal function as determined by serum creatinine were observed between the groups. We did not observe differences in the incidence of acute rejection or 1- and 2-year graft and patient survivals. Conclusion. PDDKT is the treatment of choice for ACKD. It is associated with less delayed graft function and similar 2-year graft and patient survivals than kidney transplantation after dialysis. The Charlson index reflected less comorbidity among patients with PDDKT, a finding that must influence long-term outcomes.

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