Ramachandran J, Juneja R, John L, Dutta A K, Chen J W, Woodman R J, Wigg A J
South Australian Liver Transplant Unit, Flinders Medical Centre, Adelaide, Australia.
Transplant Proc. 2010 Nov;42(9):3644-6. doi: 10.1016/j.transproceed.2010.06.022.
The incidence of chronic kidney disease (CKD) and its impact on survival have not been widely studied in the Australian liver transplant (OLT) population. The aims of this study were to evaluate the prevalence of CKD stages at various time points, calculate the cumulative incidence of progression to severe CKD, and study the impact of CKD stages on patient survival and risk factors for severe CKD in a single-center post-OLT population. We studied retrospectively 130 patients who underwent OLT in South Australia with a minimum of 6 months of follow-up from 1992 to 2008. CKD was staged according to Kidney Diseases Outcome Quality Initiative Guidelines. Glomerular filtration rate (GFR) was calculated using the Modification of Diet in Renal Disease equation. Multiple pre- and post-OLT variables were examined for their association with severe CKD. Log-rank tests and Cox regression analysis were performed to evaluate the survival data. The cumulative incidences of severe CKD (stages 4 and 5) at 2, 5, and 15 years were 3.8%, 12.7%, and 14.8%, respectively. Severe CKD was associated with an increased mortality (hazard ratio 6.5; 95% confidence interval = 2.5-17.0; P < .001). Mild and moderate CKD stages were not associated with increased mortality. Risk factors for severe CKD were: female gender, hepatitis C infection, pre-OLT diabetes, acute renal failure post-OLT, and low 1-year GFR. Mild and moderate CKD are common post-OLT. The development of severe CKD, which can be predicted early in the post-OLT period, is strongly associated with an increased mortality rate.
慢性肾脏病（CKD）的发病率及其对生存率的影响在澳大利亚肝移植（OLT）人群中尚未得到广泛研究。本研究的目的是评估不同时间点CKD各阶段的患病率，计算进展为重度CKD的累积发病率，并研究CKD各阶段对单中心OLT术后人群患者生存率的影响以及重度CKD的危险因素。我们回顾性研究了1992年至2008年在南澳大利亚接受OLT且随访至少6个月的130例患者。CKD根据肾脏病预后质量倡议指南进行分期。采用肾脏病膳食改良方程计算肾小球滤过率（GFR）。检查多个OLT术前和术后变量与重度CKD的相关性。进行对数秩检验和Cox回归分析以评估生存数据。重度CKD（4期和5期）在2年、5年和15年的累积发病率分别为3.8%、12.7%和14.8%。重度CKD与死亡率增加相关（风险比6.5；95%置信区间=2.5 - 17.0；P <.001）。轻度和中度CKD阶段与死亡率增加无关。重度CKD的危险因素为：女性、丙型肝炎感染、OLT术前糖尿病、OLT术后急性肾衰竭以及1年时GFR较低。轻度和中度CKD在OLT术后很常见。重度CKD的发生在OLT术后早期即可预测，且与死亡率增加密切相关。
