Kieslichová E, Schück O, Smrcková I, Granátová J, Skibová J, Merta D, Trunecka P
Klinika anesteziologie, resuscitace a intenzivní péce IKEM Praha.
Vnitr Lek. 2009 Dec;55(12):1126-34.
Was to analyze in detail perioperative changes of renal function during orthotopic liver transplantation (OLT) and to identify risk factors, that were associated with the need of renal replacement therapy (RRT) during the first week after liver transplantation.
Prospective study of 50 consecutive patients undergoing OLT was performed. Selected laboratory and clinical parameters were monitored prior to the procedure, after reperfusion, at the end of the procedure, and at 12 hours after the procedure. In the first post-transplant week, necessity to use RRT in the presence of acute kidney injury was monitored and the analysis of risk factors for the need for RRT was performed. Patient survival, graft function, need for dialysis and selected laboratory parameters were assessed at one year post-transplant.
During OLT, there was an increase in S(cr) and S(urea), which persisted as late as 12 hours post-transplant. There was a decrease in U(cr) and U(urea) and an increase in S(Na) and S(K). During the procedure any increase in S(cyst) were observed, increase the values were recorded 12 hours after surgery. S(bili) level decreased. There was a rise in the urinary levels of total protein, albumin and beta2-microglobulin. U(prot)/U(cr) increased significantly after reperfusion, with a peak after the procedure. At 12 hours after the procedure, there was a decrease in U(prot)/U(cr), but the values were still many times higher than those seen preoperatively. RRTwas necessary in 14% cases. Risk factors for acute kidney injury requiring RRT included a higher APACHE score, higher BMI, higher preoperative S(cr) and S(urea), hepatorenal syndrome pretransplant, blood loss and intraoperative hemodynamic instability, postoperative complications and dysfunction of the liver graft. One year after OLT, there was no difference in followed laboratory values between patients requiring postoperative RRT and others; no patient was treated with dialysis.
OLT has a major impact on glomerular and tubular renal functions. Our data suggest that patients surviving acute renal injury treated with RRT in the early postoperative period have a high chance of restoring renal function. A sensitive marker of renal injury during OLT seems to be perioperative proteinuria.
详细分析原位肝移植（OLT）围手术期肾功能的变化，并确定与肝移植后第一周内需要肾脏替代治疗（RRT）相关的危险因素。
对50例连续接受OLT的患者进行前瞻性研究。在手术前、再灌注后、手术结束时及手术后12小时监测选定的实验室和临床参数。在移植后的第一周，监测急性肾损伤时使用RRT的必要性，并对RRT需求的危险因素进行分析。在移植后一年评估患者生存率、移植物功能、透析需求和选定的实验室参数。
在OLT期间，血清肌酐（S(cr)）和血清尿素（S(urea)）升高，移植后12小时仍持续存在。尿肌酐（U(cr)）和尿尿素（U(urea)）降低，血清钠（S(Na)）和血清钾（S(K)）升高。手术期间观察到血清胱抑素（S(cyst)）有任何升高，术后12小时记录到升高值。血清胆红素（S(bili)）水平降低。尿中总蛋白、白蛋白和β2-微球蛋白水平升高。再灌注后尿蛋白/尿肌酐（U(prot)/U(cr)）显著增加，术后达到峰值。术后12小时，U(prot)/U(cr)降低，但仍比术前高出许多倍。14%的病例需要RRT。需要RRT的急性肾损伤的危险因素包括较高的急性生理与慢性健康状况评分系统（APACHE）评分、较高的体重指数（BMI）、术前较高的S(cr)和S(urea)、移植前肝肾综合征、失血和术中血流动力学不稳定、术后并发症以及肝移植物功能障碍。OLT后一年，术后需要RRT的患者与其他患者的后续实验室值无差异；没有患者接受透析治疗。
OLT对肾小球和肾小管功能有重大影响。我们的数据表明，术后早期接受RRT治疗的急性肾损伤存活患者肾功能恢复的机会很高。OLT期间肾损伤的一个敏感标志物似乎是围手术期蛋白尿。
