Guitard Joelle, Ribes David, Kamar Nassim, Muscari Fabrice, Cointault Olivier, Lavayssière Laurence, Suc Bertrand, Esposito Laure, Peron Jean-Marie, Rostaing Lionel
Multiorgan Transplant Unit, University Hospital, CHU Rangueil, Toulouse, France.
Ren Fail. 2006;28(5):419-25. doi: 10.1080/08860220600683607.
Chronic renal failure (CRF) is increasingly prevalent in solid-organ-transplant patients. This is in part related to the long-term use of calcineurin inhibitor (CNI) agents. However, in orthotopic liver-transplant (OLT) patients, the effects of superimposed hepatitis C virus (HCV)-related renal lesions could also be a factor. The aim of this cohort study (February 2000 to September, 2003) was to identify the predictive factors at one year post-transplantation for CRF in OLT patients associated with induction therapies. CRF was defined as having a creatinine clearance (CC) lower than 60 mL/min. Of the 97 transplants performed during that period, 72 were still functioning after one year. Of these, 33 patients (45.8%) had CRF. In univariate analysis, the predicting factors for CRF were recipient sex (female), initial liver disease (HCV-related cirrhosis), pre-transplant CC (<80 mL/mn), and post-transplant serum creatinine >130 micromol/L at day 3 and months (M) 1, 3, and 6. In multivariate analysis, the independent predictive factors for CRF included female sex [OR: 11.5 (2.3-58.3); p = 0.003], HCV infection [OR: 5.01 (1.1-22.7); p = 0.03], pre-OLT CC <80 mL/mn [OR: 5.4 (1.2-23.7); p = 0.025], and serum creatinine at M6 greater than 130 micromol/L [OR: 19.6 (3.7-102.5); p = 0.0004]. Among all of the predictive factors for post-OLT CRF, only one is modifiable: post-transplant serum creatinine, which could be, to some extent, related to the long-term use of CNIs.
慢性肾衰竭（CRF）在实体器官移植患者中越来越普遍。这部分与长期使用钙调神经磷酸酶抑制剂（CNI）药物有关。然而，在原位肝移植（OLT）患者中，叠加的丙型肝炎病毒（HCV）相关肾损害的影响也可能是一个因素。这项队列研究（2000年2月至2003年9月）的目的是确定OLT患者移植后一年与诱导治疗相关的CRF的预测因素。CRF定义为肌酐清除率（CC）低于60 mL/分钟。在该期间进行的97例移植中，72例在一年后仍在发挥功能。其中，33例患者（45.8%）患有CRF。在单因素分析中，CRF的预测因素为受者性别（女性）、初始肝病（HCV相关性肝硬化）、移植前CC（<80 mL/分钟）以及移植后第3天和第1、3、6个月时血清肌酐>130 μmol/L。在多因素分析中，CRF的独立预测因素包括女性性别[比值比（OR）：11.5（2.3 - 58.3）；p = 0.003]、HCV感染[OR：5.01（1.1 - 22.7）；p = 0.03]、OLT前CC<80 mL/分钟[OR：5.4（1.2 - 23.7）；p = 0.025]以及第6个月时血清肌酐大于130 μmol/L[OR：19.6（3.7 - 102.5）；p = 0.0004]。在所有OLT后CRF的预测因素中，只有一个是可改变的：移植后血清肌酐，这在一定程度上可能与长期使用CNIs有关。
