Renal transplantation in patients on long-term dialysis

Završni stadij kronične bubrežne bolesti zahtijeva liječenje nadomještanjem bubrežne funkcije. Dostupne metode su hemodijaliza, peritonealna dijaliza i transplantacija bubrega. Transplantacija bubrega je dokazano najbolja metoda liječenja zbog povoljnog utjecaja na preživljenje i kvalitetu života bolesnika, unatoč velikog broja mogućih komplikacija prouzročenih samim kirurškim zahvatom i imunosupresijom. U ovom retrospektivnom istraživanju, provedenom na Zavodu za nefrologiju, arterijsku hipertenziju, dijalizu i transplantaciju bubrega Kliničkog bolničkog centra Zagreb, istražili smo povezanost trajanja liječenja dijalizom prije transplantacije na preživljenje ispitanika i bubrežnih presadaka, kao i učestalost kirurških komplikacija. U istraživanje su uključena 72 ispitanika (61,1% muškaraca), prosječne dobi od 48,4 ± 13,8 godina , kojima je transplantiran bubreg u razdoblju od 15. kolovoza 2007. do 13, siječnja 2013. godine. Ispitanici su podijeljeni u 4 skupine s jednakim brojem ispitanika (n=18) ovisno o trajanju dijalize prije transplantacije, a podatci su prikupljeni iz medicinske dokumentacije. Uspoređeni su ishodi među skupinama, kao i ishodi među ispitanicima liječenih dijalizom manje i više od 10 godina. Nije nađena statistički značajna razlika u preživljenju ispitanika i presadaka na temelju te dvije podijele. Učestalost kirurških komplikacija poput postoperativnog krvarenja, curenja urina i limfokela također nije bila statistički značajno različita. Jedina razlika je nađena u učestalosti cijeljenja rane per secundam među ispitanicima skupine I, liječenih dijalizom više od 15 godina, i skupine III, liječenih dijalizom manje od 10 i više od 5 godina (p=0,045). Rezultati sličnih istraživanja se međusobno razlikuju, ali cjelokupna literatura ukazuje na povoljan utjecaj transplantacije bubrega na zdravstvene ishode bolesnika u usporedbi s dijalizom, bez obzira na duljinu liječenja dijalizom.End-stage renal disease requires therapy with one of the available methods of kidney function replacement. Methods include hemodialysis, peritoneal dialysis and renal transplantation. Renal transplantation has proved to be the best method of treatment, because of its beneficial effects on the survival and quality of life of patients, despite the large number of possible complications caused by the surgical procedure and immunosuppression. In this retrospective study, conducted at the Department of nephrology, arterial hypertension, dialysis and renal transplantation at University Hospital Centre Zagreb, we investigated the relationship of length of dialysis treatment before transplantation on the survival of patients and renal grafts, as well as the incidence of surgical complications. 72 patients were included in the study (61.1 % males), average age of 48.4 ± 13.8 years, who were treated with renal transplantation between August 15. 2007. and January 13. 2013.. The patients were assigned to 4 groups with equal numbers (n=18), depending on the length of dialysis treatment before transplantation, and the data was acquired from the medical records. Outcomes were compared between groups, as well as between those treated with dialysis less or more than 10 years. No statistically significant differences were found in the survival of patients or renal grafts on the basis of those two divisions. The frequency of surgical complications, such as postoperative bleeding, urine leaks and lymphoceles, was also not significantly different statistically. The only difference was found in the frequency of healing by second intention between the group I patients, treated with dialysis for more than 15 years, and group III, treated with dialysis for less than 10 and more than 5 years (p=0.045). The results of similar studies are varied, but the overall literature indicates beneficial influence of renal transplantation on the health outcomes of patients compared with dialysis, irrespective of the length of dialysis treatment