hrvatski

Hemodijaliza neposredno prije transplantacije ; da ili ne?

INTRODUCTION AND AIM: There are only few data regarding the influence of an extra hemodialysis (HD) session immediately before the transplantation (tx) on the early-graft function. Furthermore, it is unclear whether ultrafiltration (UF) during pre-transplant HD should be avoided or not. The aim of this analysis was to investigate what is the influence of pre-transplant HD as well as HD with or without UF on the early-graft function, surgical and infectious complications in the patients receiving kidney transplant. Methods: The study group comprised of 147 HD patients (mean age 58.1±11.8 years) receiving a cadaveric kidney graft in the Transplant Unit of the University Hospital Centre Rijeka between 2008 and 2014. The primary analysis was performed in 147 patients. In this group, patients treated with HD (n=90) were compared to those who didn´t received a HD treatment (n=57). In further analysis, 90 patients who received HD in the 24 h preceding tx were divided into two subgroups according to the UF application ; UF<500 ml (n=30) or UF≥500 ml (n=60). RESULTS: There was no difference due to delay graft function (DGF), rejection crises, one-year graft and patient’s survival between the patients that were treated with HD in comparison to those without HD treatment. The incidence of surgical complications (p=0.05) and infections (0.03) was significantly higher in the patients treated with HD during the first month after transplantation. Patients that were treated with UF≥500 ml had significantly higher incidence of DGF (p=0.05), higher values of serum creatinine at day 5 (p=0.03), 15 (p=0.04) and day 30 (p=0.05) after transplantation, higher incidence of surgical complications (p=0.02) and longer hospital stay (36.1±15.1 vs. 29±13.7 days ; p=0.03) in comparison to patients treated with UF<500 ml. There were no significant differences in the one-year graft survival between the patients treated with UF≥500 ml in comparison to the patients treated with UF<500 ml. CONCLUSION: Additional HD session before the tx is associated with higher incidence of surgical and infectious complications. Ultrafiltration during pre-tx dialysis is associated with more DGF, more surgical complications and longer hospital stay.

hemodijaliza ; transplantacija ; komplikacije

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