Renal transplantation following renal failure due to urological disorders
Renal transplantation following renal failure due to urological disorders
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DOI：
10.1093/ndt/13.8.2065
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发表时间：
1998-08-01
影响因子：
6.1
通讯作者：
Neild, GH
中科院分区：
文献类型：
--
作者：
Crowe, A;Cairns, HS;Neild, GH
背景资料。对因泌尿系统异常导致终末期肾功能衰竭的55例患者的56例肾移植患者进行了为期8年(1985-1992)的肾移植结局的评估。其中原发性膀胱输尿管反流或肾发育不良26例，后尿路瓣膜15例，神经性膀胱6例，膀胱输尿管结核5例，膀胱外翻3例，梅花腹部综合征1例。6例患者有增大的膀胱，7例尿流改道患者接受了8例移植手术。移植肾1、5年存活率分别为89%和66%，肌酐平均值分别为154moL/L+/-11(SE)和145+/-9。膀胱或输尿管异常患者(n=28)的移植物功能较正常膀胱患者(n=28)差，但1年和5年两组移植物存活率差异无统计学意义：膀胱正常组分别为93%和75%，系统异常组分别为86%和57%。有症状的尿路感染在移植后的前3个月很常见(63%)；39%的患者出现发热和全身症状，39%的患者膀胱正常，59%的患者膀胱异常。在6例膀胱异常的患者中，尿路感染直接导致移植物丢失，而在膀胱正常的患者中，尿路感染没有影响。移植前必须对异常膀胱进行尿动力学评估，移植后必须经常重新评估尿液引流的充分性。预防性抗生素现在用于头6个月，尿路感染必须及时治疗。通过这些措施，可以获得与没有泌尿系统问题的患者相似的良好结果。
Background. Renal allograft outcome, during an 8 year period (1985-1992), has been assessed in 56 renal transplants performed in 55 patients who had endstage renal failure as a consequence of urological abnormalities. The abnormalities were: primary vesicoureteric reflux (WR) or renal dysplasia (26 patients); posterior urethral valves (PUV) (15); neuropathic bladders (6); vesico-ureteric tuberculosis (5); bladder exstrophy (3); and prune belly syndrome (1). Six patients had augmented bladders, and eight transplants were performed in seven patients with urinary diversions.Results. Overall, 1 and 5 year actuarial graft survival was 89 and 66%, with mean creatinine of 154 mu mol/l +/- 11 (SE) and 145 +/- 9 respectively. Patients with abnormal bladders or conduits (n=28) had worse graft function than those with normal bladders (n= 28) although graft survival was not significantly different in the two groups at 1 and 5 years: 93 and 75% with normal bladders vs 86 and 57% with abnormal systems. Symptomatic urinary tract infections were common in the first 3 months after transplantation (63%); fever and systemic symptoms occurred in 39% with normal bladders and 59% with abnormal bladders. Urinary tract infection directly contributed to graft loss in six patients with abnormal bladders, but had no consequences in those with normal bladders.Conclusions. Abnormal bladders must be assessed urodynamically before transplantation, and after transplantation adequacy of urinary drainage must be re-assessed frequently. Prophylactic antibiotics are now given for the first 6 months and urinary tract infections must be treated promptly. With these measures, good results, similar to those of patients without urological problems, can be obtained.