Tumgor Gokhan, Arikan Cigdem, Kilic Murat, Aydogdu Sema
Department of Pediatric Gastroenterology, Hepatology and Nutrition, Ege University School of Medicine, Izmir, Turkey.
Pediatr Transplant. 2006 Sep;10(6):665-8. doi: 10.1111/j.1399-3046.2006.00556.x.
Hyperuricemia is common after renal and cardiac transplantations, but it is rarely reported after liver transplantations. The aim of this study is to determine the frequency of hyperuricemia in children following orthotopic liver transplantation and the effects of calcineurin inhibitors tacrolimus and cyclosporine) on blood uric acid levels. Between September 1997 to January 2004, 76 liver transplantations were performed in 70 children (male/female; 39/31) at Ege University, Organ Transplantation Center (37 deceased donation and 39 live donors). Patients who had been transplanted within the last three months and patients who died within six months after liver transplantation were excluded from the study. Finally 59 patients were included in this study. Uric acid levels were measured before transplantation and after transplantation within six months intervals for two yr. In these series 17 cases had increased uric acid levels after liver transplantation (28.8%). Serum uric acid levels in both groups (tacrolimus or cyclosporine) were detected to be significantly higher than initial values at 12th months (p < 0.05). Hyperuricemia developed in eight patients receiving cyclosporine (eight of 11; 72%) whereas nine patients receiving tacrolimus developed hyperuricemia (nine of 48; 18%). However, the rate of having high uric acid levels was significantly higher in cyclosporine group compared tacrolimus group (p = 0.001, OR: 11.5, CI 95% 2.5-52.4). Uric acid levels were also significantly higher in cyclosporine group in 12th and 18th months (respectively, p = 0.003 and p = 0.003). Serum creatinine levels at 12th, 18th and 24th months were significantly higher in cyclosporine group than tacrolimus group (respectively, p = 0.009, p = 0.04 and p = 0.02). Hyperuricemia is a common complication after liver transplantation in children. Cyclosporine may cause hyperuricemia more often in respect to tacrolimus and this may be related to the impairment of renal functions. Complications developing because of hyperuricemia such as gout disease or renal calculi are quite rare in children.
高尿酸血症在肾移植和心脏移植后很常见，但在肝移植后鲜有报道。本研究的目的是确定原位肝移植术后儿童高尿酸血症的发生率以及钙调神经磷酸酶抑制剂他克莫司和环孢素对血尿酸水平的影响。1997年9月至2004年1月期间，在伊兹密尔大学器官移植中心对70名儿童（男/女；39/31）进行了76例肝移植手术（37例为尸检供体，39例为活体供体）。研究排除了在过去三个月内接受移植的患者以及肝移植术后六个月内死亡的患者。最终59例患者纳入本研究。在两年内，于移植前及移植后每隔六个月测量尿酸水平。在这些病例中，17例（28.8%）肝移植术后尿酸水平升高。两组（他克莫司组或环孢素组）的血清尿酸水平在第12个月时均显著高于初始值（p < 0.05）。接受环孢素治疗的11例患者中有8例（72%）发生高尿酸血症，而接受他克莫司治疗的48例患者中有9例（18%）发生高尿酸血症。然而，环孢素组的高尿酸水平发生率显著高于他克莫司组（p = 0.001，OR：11.5，95%CI 2.5 - 52.4）。在第12个月和第18个月时，环孢素组的尿酸水平也显著更高（分别为p = 0.003和p = 0.003）。环孢素组在第12个月、第18个月和第24个月时的血清肌酐水平显著高于他克莫司组（分别为p = 0.009、p = 0.04和p = 0.02）。高尿酸血症是儿童肝移植术后的常见并发症。相对于他克莫司，环孢素可能更常导致高尿酸血症，这可能与肾功能损害有关。因高尿酸血症引发的并发症，如痛风或肾结石，在儿童中相当罕见。
