Schell M, Lachaux A, Hadj-Aïssa A, Dubourg L, Mahmoud A, Boillot O, Saïd M H, Cochat P
Département de Pédiatrie, H pital Edouard Herriot, Lyon, France.
Pediatr Transplant. 2001 Feb;5(1):51-5. doi: 10.1034/j.1399-3046.2001.00034.x.
In a prospective longitudinal study, we investigated the renal function (RF) of 23 children before and after orthotopic liver transplantation (OLT). The aim was to assess both the outcome of pretransplant hyperfiltration and the clinical nephrotoxic effects of cyclosporin A (CsA); children with decreased RF prior to OLT were therefore excluded. The RF study of the 13 remaining patients included glomerular filtration rate (GFR) and effective renal plasma flow (RPF) measured by inulin (Cin: mL/min/1.73 m2) and para-amino hippurate (Cpah: mL/min/1.73 m2) clearances, respectively. Hyperfiltration prior to OLT was observed in six children, i.e. Cin>170 [range 172-230] and Cpah>800 [808-1,133]. A significant decrease in RF was noted as soon as 6 months after OLT: Cin (mean+/-SD)=107+/-23 vs. 158+/-46 (p<0.003); Cpah=583+/-119 vs. 791+/-243 (p<0.004). This was due to loss of hyperfiltration in the six children, as there was no significant difference in RF before and 6 months after OLT in the other seven children. With a 36-month follow-up, there was no correlation between CsA trough blood level and RF. In conclusion, following OLT, RF underwent early changes owing to loss of prior hyperfiltration in children without impaired RF before OLT. In addition, no evidence of CsA nephrotoxicity was found and RF remained stable during follow-up.
在一项前瞻性纵向研究中，我们调查了23名儿童原位肝移植（OLT）前后的肾功能（RF）。目的是评估移植前超滤的结果以及环孢素A（CsA）的临床肾毒性作用；因此排除了OLT前肾功能下降的儿童。对其余13名患者的肾功能研究包括分别通过菊粉（Cin：mL/min/1.73 m²）和对氨基马尿酸（Cpah：mL/min/1.73 m²）清除率测量的肾小球滤过率（GFR）和有效肾血浆流量（RPF）。在6名儿童中观察到OLT前存在超滤，即Cin>170 [范围172 - 230]且Cpah>800 [808 - 1,133]。OLT后6个月时即发现肾功能显著下降：Cin（均值±标准差）=107±23，而术前为158±46（p<0.003）；Cpah = 583±119，术前为791±243（p<0.004）。这是由于6名儿童超滤消失所致，因为其他7名儿童OLT前后肾功能无显著差异。经过36个月的随访，CsA血药谷浓度与肾功能之间无相关性。总之，OLT后，由于OLT前肾功能未受损的儿童先前超滤的消失，肾功能出现早期变化。此外，未发现CsA肾毒性的证据，且随访期间肾功能保持稳定。
