Gonwa Thomas A, Jennings Linda, Mai Martin L, Stark Paul C, Levey Andrew S, Klintmalm Goran B
Department of Transplantation, Mayo Clinic, Jacksonville, FL 32216, USA.
Liver Transpl. 2004 Feb;10(2):301-9. doi: 10.1002/lt.20017.
The ability to estimate rather than measure the glomerular filtration rate (GFR) in patients before and after liver transplantation would be helpful in estimating risk, dosing drugs, and assessing long-term toxicity of calcineurin inhibitors. Currently available equations for estimating the GFR have not been validated in either the pre- or post-liver transplant population. We have evaluated the performance of currently used formulas for the estimation of the GFR in this setting. Data were collected prospectively on patients who underwent liver transplantation between 1984 and 2001. GFR per 1.73 m2 was measured by I125 iothalamate in patients at the pretransplant evaluation and at 3 months, 1 year, and yearly posttransplant thereafter. GFR estimated by the Cockcroft-Gault equation, the Nankivell equation, and the equations from the Modification of Diet in Renal Disease (MDRD) Study (6, 5, and 4 variables) was compared with the measured GFR. Pretransplant GFR was available in 1,447 patients. The mean GFR was 90.7 +/- 40.5 mL/min. Values for r and r2 were highest for the MDRD Study 6-variable equation (0.70 and 0.49, respectively). Only 66% of estimates were within 30% of the measured GFR. At 3 months, 1 year, and 5 years posttransplant, the mean GFR was 59.5 +/- 27.1 mL/min, 62.7 +/- 27.8 mL/min, and 55.3 +/- 26.1 mL/min, respectively. Values for r and r(2) for the MDRD Study 6-variable equations at 1 and 5 years posttransplant were 0.74 (0.55) and 0.76 (0.58), respectively. At these time points, however, only 67% and 64% of the estimated GFR were within 30% of the measured GFR. MDRD Study equations had greater precision than other equations, but the precision was lower than reported for MDRD estimation of GFR in other populations. Better methods for estimating the GFR are required for evaluation of renal function before and after liver transplantation.
在肝移植患者术前和术后估算而非测量肾小球滤过率（GFR）的能力，有助于评估风险、调整药物剂量以及评估钙调神经磷酸酶抑制剂的长期毒性。目前可用的估算GFR的公式在肝移植术前或术后人群中均未得到验证。我们评估了当前使用的公式在此情况下估算GFR的性能。前瞻性收集了1984年至2001年间接受肝移植患者的数据。在移植前评估时以及移植后3个月、1年及此后每年，通过碘他拉酸I125测量每1.73 m2的GFR。将Cockcroft-Gault公式、Nankivell公式以及来自肾脏疾病饮食改良（MDRD）研究的公式（6变量、5变量和4变量）估算的GFR与测量的GFR进行比较。1447例患者有移植前GFR数据。平均GFR为90.7±40.5 mL/分钟。MDRD研究6变量公式的r和r2值最高（分别为0.70和0.49）。只有66%的估算值在测量GFR的30%范围内。移植后3个月、1年和5年时，平均GFR分别为59.5±27.1 mL/分钟、62.7±27.8 mL/分钟和55.3±26.1 mL/分钟。移植后1年和5年时，MDRD研究6变量公式的r和r2值分别为0.74（0.55）和0.76（0.58）。然而，在这些时间点，只有67%和64%的估算GFR在测量GFR的30%范围内。MDRD研究公式比其他公式具有更高的精度，但该精度低于在其他人群中MDRD估算GFR时所报告的精度。在评估肝移植前后的肾功能时，需要更好的估算GFR的方法。
