Cohen Ari J, Stegall Mark D, Rosen Charles B, Wiesner Russell H, Leung Nelson, Kremers Walter K, Zein Nizar N
Department of Surgery, Division of Transplantation, Mayo Clinic, Rochester, MN 55905, USA.
Liver Transpl. 2002 Oct;8(10):916-21. doi: 10.1053/jlts.2002.35668.
With the increasing success of liver transplantation, more patients are developing late complications such as renal dysfunction. The goal of the current study was to assess the prevalence of renal dysfunction years after liver transplantation and to identify patients at risk for the development of this complication. Of the 527 liver transplantations performed at our institution between April 1990 and October 1998, 353 had pretransplantation and posttransplantation glomerular filtration rate (GFR) determinations by iothalamate clearance. From this entire group, 198 patients had actual 4-year follow-up and 52 had actual 6-year follow-up. In addition, 191 of these patients had intensive follow-up with GFR measurements pretransplantation and at 1 and 3 years posttransplantation (complete follow-up group). All patients received either tacrolimus- or cyclosporine-based immunosuppression. The overall mean GFR levels in both of these groups was acceptable and was not different in cyclosporine- versus tacrolimus-based immunosuppressive regimens. Renal dysfunction was progressive, with 27.5% of patients in the intensive group having a GFR < 40 mL/min/body surface area 5 years after transplantation. GFR pretransplantation did not correlate well with late renal function; however, GFR at 1 year identified patients with subsequent renal dysfunction. The cumulative incidence of renal failure for the entire group was 6.25% at 7 years and 10% at 10 years. Renal dysfunction is a major late complication after liver transplantation. The GFR at 1 year correlates best with late renal function. Patients with a low GFR at 1 year (< 40 mL/min/BSA) are a high-risk group that might benefit from early therapeutic interventions aimed at preventing subsequent renal failure.
随着肝移植成功率的不断提高，越来越多的患者出现诸如肾功能不全等晚期并发症。本研究的目的是评估肝移植数年之后肾功能不全的患病率，并确定发生该并发症的风险患者。1990年4月至1998年10月在我们机构进行的527例肝移植中，353例通过碘他拉酸盐清除率测定了移植前和移植后的肾小球滤过率（GFR）。在这整个组中，198例患者进行了实际4年的随访，52例进行了实际6年的随访。此外，这些患者中有191例在移植前以及移植后1年和3年进行了GFR测量的强化随访（完整随访组）。所有患者均接受了以他克莫司或环孢素为基础的免疫抑制治疗。这两组的总体平均GFR水平均可接受，并且在基于环孢素与基于他克莫司的免疫抑制方案中并无差异。肾功能不全呈进行性发展，强化组中27.5%的患者在移植后5年GFR<40 mL/（min·体表面积）。移植前GFR与晚期肾功能的相关性不佳；然而，1年时的GFR可识别出随后发生肾功能不全的患者。整个组的肾衰竭累积发生率在7年时为6.25%，在10年时为10%。肾功能不全是肝移植后的主要晚期并发症。1年时的GFR与晚期肾功能的相关性最佳。1年时GFR低（<40 mL/（min·BSA））的患者是高危人群，可能会从旨在预防随后肾衰竭的早期治疗干预中获益。
