Herlenius Gustaf, Fägerlind Mattias, Krantz Marie, Mölne Johan, Olausson Michael, Gäbel Markus, Friman Vanda, Oltean Mihai, Friman Styrbjörn
Department of Transplantation and Liver Surgery, Sahlgrenska University Hospital, Göteborg, Sweden.
Transplantation. 2008 Jul 15;86(1):108-13. doi: 10.1097/TP.0b013e31817613f8.
Chronic kidney disease after organ transplantation is a serious complication that negatively impacts on long-term patient survival. We describe long-term renal function after intestinal transplantation by serial measurements of glomerular filtration rates (GFR) with Chromium EDTA clearance.
Ten patients with at least 6 months survival form the basis of this report. Glomerular filtration rate measurements were performed at baseline, 3 months posttransplantation, and yearly thereafter. Median follow-up time for the cohort was 1.5 years (0.5-7.8 years). Tacrolimus (Prograf) was discontinued in four patients because of impaired renal function. These four patients were switched to sirolimus (Rapamune) at 11, 18, 24, and 40 months posttransplantation.
Median baseline GFR was 67 (22-114) mL/min/1.73 m. In the adult patients, GFR 3 months posttransplantation had decreased to 50% of the baseline. At 1 year, median GFR in the adult patients was reduced by 72% (n=5). Two patients developed renal failure within the first year and required hemodialysis. One of the pediatric patients fully recovered her renal function, the second pediatric patient lost 20% of her baseline GFR at 6 months posttransplantation. Glomerular filtration rate calculated with the modified diet in renal disease formula consistently overestimated GFR by approximately 30% compared with measured GFR.
Chronic kidney disease and renal failure are common after intestinal transplantation. These two factors significantly contribute to poor long-term survival rates. Measurements of GFR may help to identify those individuals at risk for developing chronic kidney disease to implement renal sparing strategies.
器官移植后的慢性肾脏病是一种严重并发症，对患者长期存活有负面影响。我们通过用铬标记的乙二胺四乙酸清除率连续测量肾小球滤过率（GFR）来描述肠移植后的长期肾功能。
本报告基于10例存活至少6个月的患者。在基线、移植后3个月及此后每年进行肾小球滤过率测量。该队列的中位随访时间为1.5年（0.5 - 7.8年）。4例患者因肾功能受损停用他克莫司（普乐可复）。这4例患者在移植后11、18、24和40个月改用西罗莫司（雷帕鸣）。
基线GFR中位数为67（22 - 114）ml/min/1.73m²。成年患者移植后3个月GFR降至基线的50%。1年时，成年患者GFR中位数降低了72%（n = 5）。2例患者在第一年内发生肾衰竭，需要血液透析。1例儿科患者肾功能完全恢复，另1例儿科患者在移植后6个月时GFR较基线降低了20%。与测量的GFR相比，用肾脏病改良饮食公式计算的肾小球滤过率始终高估GFR约30%。
肠移植后慢性肾脏病和肾衰竭很常见。这两个因素显著导致长期存活率低下。GFR测量可能有助于识别那些有发生慢性肾脏病风险的个体，以便实施肾脏保护策略。
