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目的探讨未透析的尿毒症患者直接进行肾移植的临床可行性和优越性。方法回顾性分析146例未透析直接行肾移植的尿毒症患者(未透析组)和同期653例透析后肾移植患者(透析组)的临床资料,并将两组资料进行统计学比较。结果未透析组和透析组术前肝炎病毒感染率分别为5．48％和19．14％,差异有统计学意义(P<0．05)。未透析组和透析组术后血肌酐恢复正常的时间及术后1个月的血红蛋白和白蛋白水平差异均无统计学意义(P>0．05)。未透析组术后急性排斥反应、肾功能延迟恢复和肝功能损害的发生率分别为19．18％、6．16％和9．59％,透析组分别为33．54％、13．02％和25．57％,2组比较,差异均有统计学意义(P<0．05);2组患者术后高血压和感染的发生率比较,差异均无统计学意义(P>0．05)。未透析组人／肾1年存活率均为98．63％,3年存活率均为95．95％。透析组人／肾1年存活率为97．24％/95．71％,3年存活率为94．37％／89．20％;2组比较,差异均无统计学意义(P>0．05)。结论未透析患者肾移植与透析后肾移植的临床治疗效果相当,并可避免透析的并发症和输血致敏,且术后急性排斥发生率低。因此,未透析的尿毒症患者直接行肾移植具有较明显的优势,临床上是完全可行的。
Objective To investigate the clinical feasibility and superiority of direct renal transplantation in patients with uremia without dialysis. Methods A retrospective analysis of 146 cases of uremic patients without dialysis direct renal transplantation (non-dialysis group) and the same period 653 cases of dialysis patients after dialysis (dialysis group) clinical data, and the two groups of data for statistical comparison. Results The pre-infection rates of hepatitis B virus in non-dialysis group and dialysis group were 5.48% and 19.14%, respectively, with statistical significance (P <0.05). There was no significant difference in hemoglobin and albumin level between the non-dialysis group and the dialysis group after the serum creatinine returned to normal level and one month after the operation (P> 0.05). The incidences of postoperative acute rejection, delayed renal function recovery and hepatic dysfunction in non-dialysis group were 19.18%, 6.16% and 9.59%, respectively, and those in dialysis group were 33.54% and 13.02% respectively And 25.57%, respectively. There was significant difference between the two groups (P <0.05). There was no significant difference in the incidence of postoperative hypertension and infection between the two groups (P> 0.05 ). The 1-year survival rate of non-dialysis patients / kidney was 98.63%, and the 3-year survival rates were 95.95%. The one-year survival rate in dialysis group was 97.24% / 95.71% and the three-year survival rate was 94.37% / 89.20%. There was no significant difference between the two groups (P> 0.05). 05). Conclusion The renal transplantation in non-dialysis patients is equivalent to the renal transplantation after dialysis. The dialysis complications and transfusion sensitization can be avoided, and the incidence of postoperative acute rejection is low. Therefore, uremic patients without dialysis have direct renal transplantation has obvious advantages, is clinically feasible.