探讨术前不同透析方式及时长对肾移植预后的影响。

回顾性分析2015年1月至2019年6月在武汉大学人民医院行同种异体肾移植且术前接受透析治疗、术后定期随访的451例受者资料。根据术前透析方式的不同，将451例受者者分为血液透析(HD)组(n＝365)和腹膜透析(PD)组(n＝86)；根据术前透析时长的不同将受者分为透析时长≤1年组(n＝214)，透析时长>1~<3年组(n＝118)，透析时长≥3年组(n＝119)。随访截至2022年6月30日，比较两组受者肾移植术后不同时间血清肌酐水平、并发症发生率，以及术后3年内受者/移植肾存活率。计量资料采用成组t检验或Mann-Whitney U检验比较，计数资料采用χ²检验比较，两两比较采用χ²分割法(检验水准α′＝α/3＝0.0167)。采用Kaplan-Meier法绘制生存曲线，并采用log-rank检验比较受者/移植肾生存率。P<0.05为差异有统计学意义。

PD组与HD组受者年龄、性别、体质指数、术前透析时长、术前合并症及原发病等一般资料差异均无统计学意义(P均>0.05)。两组受者移植肾功能恢复良好，术后不同时间血清肌酐水平差异均无统计学意义(P均>0.05)，且术后移植肾功能延迟恢复(DGF)、肺部感染、急性排斥反应(AR)、移植肾血管并发症、心血管疾病(CVD)及泌尿系统并发症的发生率差异均无统计学意义(P均>0.05)。术前透析时长≤1年、>1~<3年和≥3年的3组受者DGF和AR发生率差异均有统计学意义；其中，透析时长≥3年组DGF和AR发生率均高于透析时长≤1年组(χ²＝7.13和13.962，P均<0.0167)。PD组和HD组术后3年受者生存率分别为94.2%和95.3%，移植肾生存率分别为91.9%和91.0%，差异均无统计学意义(χ²＝0.029和0.112，P均>0.05)。术前透析时长≤1年、>1~<3年和≥3年的3组受者术后3年生存率分别为96.3%、94.9%和93.3%，移植肾生存率分别为93.0%、89.8%和89.1%，差异均无统计学意义(χ²＝1.483和1.785，P均>0.05)。

肾移植术前不同透析方式对术后移植肾功能恢复、并发症及受者/移植肾生存率无明显影响，但术前透析时长增加会导致术后DGF和AR发生率升高。

To investigate the impact of different preoperative dialysis modalities and durations on the prognosis of renal transplantation.

The clinical data of 451 recipients who underwent allogeneic renal transplantation at the Remin Hospital of Wuhan University from January 2015 to June 2019, and received dialysis before operation and were followed up regularly after operation were analyzed retrospectively. According to different preoperative dialysis methods, 451 recipients were divided into hemodialysis (HD) group (n=365) and peritoneal dialysis (PD) group (n=86). According to different preoperative dialysis duration, recipients were also divided into dialysis duration ≤1 year group (n=214), dialysis duration >1-<3 years group (n=118), and dialysis duration ≥3 years group (n=119). The follow-up deadline was June 30, 2022. The serum creatinine level, the incidence rate of complications and the survival rate of recipients/transplanted kidneys within 3 years after renal transplantation were compared between the two groups. Measurement data were compared by group t-test or Mann-Whitney U test, enumeration data were compared by χ² test. Survival curves were plotted using the Kaplan-Meier method and recipient/graft survival was compared using the log-rank test. P<0.05 was considered statistically significant.

There were no statistical differences in age, sex, body mass index, length of preoperative dialysis, preoperative complications and primary disease between the PD group and HD group (P>0.05). Renal allograft function recovered well in both groups, there was no statistical difference in serum creatinine level at different time after operation (P>0.05). There were no statistical differences in incidence of delayed graft function (DGF), pulmonary infection, acute rejection (AR), renal allograft vascular complications, cardiovascular disease (CVD) and urinary system complications after operation between the two groups (P>0.05). There were significant differences in the incidence of DGF and AR among the three groups of recipients with preoperative dialysis duration ≤1 year, >1-<3 years and ≥3 years. The incidence of DGF and AR in the group with dialysis duration ≥3 years was higher than that in the group with dialysis duration ≤1 year (χ²=7.13 and 13.962, P<0.0167). The survival rates of recipients at 3 years after operation in the PD group and HD group were 94.2% and 95.3%, respectively, and the survival rates of transplanted kidneys were 91.9% and 91.0%, respectively, and the differences were not statistically significant (χ²=0.029 and 0.112, P>0.05). The 3-year survival rates of recipients in the three groups with preoperative dialysis duration ≤1 year, >1-<3 years and ≥3 years were 96.3%, 94.9% and 93.3%, respectively, and the renal allograft survival rates were 93.0%, 89.8% and 89.1%, respectively, and the differences were not statistically significant (χ²=1.483 and 1.785, P>0.05).

Different dialysis methods before renal transplantation have no significant effect on the recovery of renal allograft function, complications, and recipient/renal allograft survival rate, but the prolonged duration of preoperative dialysis will lead to an increase in the incidence of DGF and AR.