Utjecaj tipa dijalize prije transplantacije na ishod transplantacije bubrega

doctoral thesis

• Title (english): The effect of pretransplant dialysis modality on the outcome of renal transplantation
• Author: Ivan Neretljak
• Mentor: Mladen Knotek (mentor)
• Committee member: nije dostupno (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2017-11-20, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences
• Universal decimal classification (UDC): 61 - Medical sciences

Abstract

Uvod: Kronična bubrežna bolest je globalna bolest koja prvenstveno zahvada stariju populaciju te predstavlja veliki financijski trošak za svaki zdravstveni sustav. Liječenje kronične bubrežne bolesti se provodi putem dijalize ili transplantacijom bubrega. Cilj istraživanja je vidjeti povezanost tipa dijalize prije transplantacije na ishod transplantacije bubrega. Ispitanici i metode: U ovu retrospektivnu studiju su uključeni svi primatelji bubrega, odnosno pankreasa i bubrega, u razdoblju od 2007. do 2013. godine u KB Merkur, Zagreb.
Rezultati: U istraživanje je uključeno 280 bolesnika (106 muškaraca i 174 žene). Od ukupnog broja transplantacija je učinjeno 229 transplantacija bubrega te 51 simultana transplantacija bubrega i gušterače. Prije transplantacije vedina bolesnika je bila na HD (207) dok ih je 63 bilo na PD. Prema Kaplan Meier krivulji preživljenja petogodišnje preživljenje svih bolesnika iznosi 82.9 % dok preživljenje grafta iznosi 78.5%. U odnosu na tip dijalize prije transplantacije nije bilo statistički značajne razlike u preživljenju bolesnika (p=.09), preživljenju bubrega (p=.19) te u preživljenju grafta cenzuriranom za smrt bolesnika (p=.16). Incidencija svih infekcija u prva tri mjeseca nakon transplantacije je iznosila 58.9% od čega su urinarne infekcije činile gotovo 50% svih infekcija. U odnosu na tip dijalize prije transplantacije nije bilo statistički značajne razlike u incidenciji infekcija. Iako je u univarijatnoj analizi tip dijalize prije transplantacije bio jedan od čimbenika koji su utjecali na vrijednost glomerularne filtracije isto se izgubio u multivarijatnoj analizi gdje su samo dob primatelja i darivatelja ostale statistički značajne varijable koje utječu na funkciju bubrega 6 i 12 mjeseci nakon transplantacije. Prosječna cijena transplantacije bubrega je iznosila 85.85±41.67 tisuda kuna, dok je za SPKT iznosila 111.84±89.20 tisuda kuna (p= .02). Nije bilo statistički značajne razlike u cijeni transplantacije u odnosu na tip dijalize prije transplantacije. Odgođena funkcija grafta, smrt bolesnika, vrsta transplantacije te preživljenje grafta cenzuriranog za smrt bolesnika su statistički značajne varijable povezane s cijenom transplantacije.
Zaključak: Vrsta dijalize prije transplantacije ne utječe na preživljenje bolesnika i grafta, pojavnost infekcija i vrijednost glomerularne filtracije nakon transplantacije te na cijenu same transplantacije. Peritonejska dijaliza je jeftinija od hemodijalize te je manje financijsko opteredenje za javnozdravstveni sustav. Zbog toga se PD treba promovirati u metodu prvog odabira, kada je u pitanju liječenje dijalizom, u svih bolesnika koji nemaju kontraindikaciju za njezino provođenje.

Abstract (english)

Introduction: Chronic renal disease is a global disease that primarily affects the elderly population and represents a major financial expense for all healthcare systems. Chronic renal disease is treated by dialysis or kidney transplantation. The goal of the research is to discover the connection between the type of dialysis before the transplantation and the outcome of the kidney transplantation.
Test subjects and methods: This retrospective study includes all kidney recipients or pancreas and kidney recipients in the period from 2007. to 2013. at the University Hospital Merkur, Zagreb.
Results: The research included 280 patients (106 male and 174 female). Of the total number of transplantations, there were 229 kidney transplantations and 51 simultaneous kidney and pancreas transplantations. Before the transplantation most of the patients were on HD (207), while 63 of them were on PD. According to the Kaplan-Meier survival curve, the five year survival of all the patients is 82.9 % while the graft survival is 78.5%). Considering the type of dialysis before the transplantation, there was no statistically significant differences in the survival of the patients (p=.09), kidney survival (p=.19), and graft survival censored for death of the patient (p=.16). The incidence of all infections in the first three months after transplantation was 58.9%, and 50% of all the infections were urinary infections. Considering the type of dialysis before transplantation, there were no statistically significant differences in the incidence of infections. Even though the type of dialysis before the transplantation was one of the factors that affected the value of glomerular filtration in the univariate analysis, it was lost in the multivariate analysis, where only the ages of the recipient and the donor remained as statistically significant variables that affect the function of the kidneys 6 and 12 months after the transplantation. The average price of a kidney transplantation was HRK 85.85±41.67 thousand, and for SPKT it was HRK 111.84±89.20 thousand (p= .02). There was no statistically significant difference in the price of the transplantation considering the type of dialysis before the transplantation. Delayed graft function, death of the patient, type of transplantation, and graft survival censored for death of the patient are statistically significant variables connected to the price of the transplantation. Conclusion: The type of dialysis before transplantation does not affect the survival of the patient and the graft, the incidence of infections, the value of glomerular filtration after the transplantation, or the price of the transplantation itself. That is why PD should be promoted as the first choice method for dialysis treatment of all the patients that do not have contraindications for its use.

• Keywords: medicina
• Keywords (english): medicine
• Language: croatian
• URN:NBN: urn:nbn:hr:105:566996
• Study programme: Title: Biomedicine and Health Sciences; Study programme type: university; Study level: postgraduate; Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstva (doktor/doktorica znanosti, područje biomedicine i zdravstva)
• Type of resource: Text
• Extent: 88 str.
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-05-05 08:20:44