Burra P, Senzolo M, Masier A, Prestele H, Jones R, Samuel D, Villamil F
Gastroenterology, Department of Surgical and Gastroenterological Sciences, University Hospital Padova, Padova, Italy.
Dig Liver Dis. 2009 May;41(5):350-6. doi: 10.1016/j.dld.2008.09.018. Epub 2008 Nov 28.
Renal failure, both acute and chronic, is a common complication after liver transplantation and can seriously jeopardise long-term outcome. Given organ shortage it should be essential to determine which patients will experience progressive and severe renal dysfunction after liver transplantation (LT).
To correlate pre-transplant renal function and risk factors for renal failure after liver transplantation with occurrence of renal failure at 1 and 5 years after LT, with particular attention to hepatitis C virus (HCV) infection.
Data from patients enrolled in the liver section of Neoral MOST (Multinational Observational Study in Transplantation) study were used for the analysis. HCV status, pre-transplant serum creatinine level, recipient gender, recipient age, pre-transplant arterial hypertension, pre-transplant diabetes mellitus, pre-transplant antiviral therapy, the time of the transplant (before or after 2000) and immunosuppressive regimen were collected for each patient. Post-transplant occurrence of renal failure at 1 and 5 years was defined as a GFR<60 mL/min/1.73 m(2) (Stage III of the National Kidney Foundation).
Data from 1948 patients enrolled in the study were considered. Glomerular filtration rate (GFR) was evaluated in 406 patients at 1 year and in 233 patients at 5 years after LT. The prevalence of HCV infection was 35% in the former and 37% in the latter. The median GFR was 70 mL/min/1.73 m(2) after 1 year and 69 mL/min after 5 years, significantly lower in HCV-positive (HCV+) than in HCV-negative (HCV-) patients both 1 and 5 years after LT (p<0.001). GFR before transplant correlated with GFR at 1 month, 1 and 3 years (p<0.0001 for all correlations). Multivariate analysis confirmed HCV status, pre-LT serum creatinine levels and recipient gender as significant predictors of 1-year GFR (p<0.001 for all three). Further analysis of the effect of recipient gender indicated that the only significant risk factor observed in both male and female patients was HCV positivity. Only 1-year GFR was an independent predictor of 5-year GFR (p<0.001). HCV+ status, cyclosporine (CsA) exposure, antiviral therapy and diabetes mellitus had no significant influence on 5-year GFR.
HCV status and pre-LT serum creatinine levels were independent predictors of renal function a year after LT, together with GFR before transplant. The negative impact of HCV positivity on renal function was not confirmed in the long term, whereas the prognostic influence of an abnormal renal function in the early post-transplant period was more persistent.
急性和慢性肾衰竭是肝移植术后常见的并发症，可严重危及长期预后。鉴于器官短缺，确定哪些患者在肝移植（LT）后会出现进行性和严重的肾功能障碍至关重要。
将肝移植术前肾功能及肾衰竭风险因素与肝移植后1年和5年肾衰竭的发生情况相关联，尤其关注丙型肝炎病毒（HCV）感染。
分析纳入Neoral MOST（移植领域多国观察性研究）肝脏部分研究的患者数据。收集每位患者的HCV状态、移植前血清肌酐水平、受者性别、受者年龄、移植前动脉高血压、移植前糖尿病、移植前抗病毒治疗、移植时间（2000年之前或之后）及免疫抑制方案。将移植后1年和5年肾衰竭的发生定义为肾小球滤过率（GFR）<60 mL/min/1.73 m²（美国国家肾脏基金会III期）。
纳入研究的1948例患者的数据纳入分析。肝移植后1年对406例患者、5年对233例患者评估了肾小球滤过率（GFR）。前者HCV感染患病率为35%，后者为37%。1年后GFR中位数为70 mL/min/1.73 m²，5年后为69 mL/min，肝移植后1年和5年时，HCV阳性（HCV+）患者的GFR显著低于HCV阴性（HCV-）患者（p<0.001）。移植前GFR与移植后1个月、1年和3年的GFR相关（所有相关性p<0.0001）。多变量分析证实HCV状态、肝移植前血清肌酐水平和受者性别是1年GFR的显著预测因素（三者均p<0.001）。对受者性别的影响进一步分析表明，男性和女性患者中观察到的唯一显著风险因素是HCV阳性。只有1年GFR是5年GFR的独立预测因素（p<0.001）。HCV+状态、环孢素（CsA）暴露、抗病毒治疗和糖尿病对5年GFR无显著影响。
HCV状态和肝移植前血清肌酐水平是肝移植术后1年肾功能的独立预测因素，移植前GFR也如此。从长期来看，HCV阳性对肾功能的负面影响未得到证实，而移植后早期肾功能异常的预后影响更持久。
