儿童肝移植后的长期肾功能。

Long-term renal function in children after liver transplantation.

机构信息

Department of Pediatric Nephrology and Transplantation, Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland.

出版信息

Transplantation. 2011 Jan 15;91(1):115-20. doi: 10.1097/tp.0b013e3181fa94b9.

DOI:10.1097/tp.0b013e3181fa94b9

PMID:21452415

Abstract

BACKGROUND

Reduced renal function after liver transplantation (LT) is a long-term extrahepatic complication of major concern caused at least partly by calcineurin inhibitor nephrotoxicity. We report on long-term renal function after LT in children from a single center and analyze the usefulness of glomerular filtration rate (GFR) estimation methods in the follow-up of pediatric LT patients.

METHODS

Fifty-seven pediatric patients were included. GFRs were measured by 51-labeled chromium ethylenediaminetetraacetic acid clearance before LT, at discharge, 6, 12, 18, and 24 months after transplantation and annually thereafter and corrected with the modified Brochner-Mortensen equation. GFR values of cases with an ethylenediaminetetraacetic acid distribution volume less than 15% or more than 35% were excluded.

RESULTS

The mean GFR for overall follow-up was 76.0 mL/min/1.73 m2 (+/-22.2 mL/min/1.73 m2). The GFR declined significantly from 5 to 7 years (80.2 [+/-17.7] to 72.9 [+/-13.3] mL/min/1.73 m2, respectively; P<0.05). Thirteen percent, 21%, 31%, and 33% of patients had stage 3 chronic kidney disease at 5, 7, 10, and 15 years after LT, respectively. The cyclosporine A trough level was a significant time-dependent factor in the regression model, and after time was removed from the model, proteinuria was the most significant factor. GFR estimation methods overestimated measured GFR; 11% with updated Schwartz, 50% with Schwartz 1987, and 31% with Counahan-Barratt.

CONCLUSIONS

This study underlines the importance of long-term renal function surveillance after LT performed on children. Although measuring GFR remains the preferred function surveillance method, the updated Schwartz formula is also acceptable.

摘要

背景

肝移植（LT）后肾功能下降是一个长期的肝外并发症，引起了广泛关注，其至少部分原因是钙调神经磷酸酶抑制剂的肾毒性。我们报告了来自单个中心的儿童 LT 后的长期肾功能，并分析了肾小球滤过率（GFR）估计方法在儿科 LT 患者随访中的作用。

方法

纳入 57 例儿科患者。在 LT 前、出院时、移植后 6、12、18 和 24 个月以及此后每年，通过 51 铬乙基乙二胺四乙酸清除率测量 GFR，并采用改良 Brochner-Mortensen 方程进行校正。排除乙基乙二胺四乙酸分布容积小于 15%或大于 35%的病例。

结果

总体随访的平均 GFR 为 76.0 mL/min/1.73 m2（+/-22.2 mL/min/1.73 m2）。GFR 从 5 年到 7 年显著下降（分别为 80.2[+/-17.7]和 72.9[+/-13.3]mL/min/1.73 m2；P<0.05）。分别有 13%、21%、31%和 33%的患者在 LT 后 5、7、10 和 15 年时患有 3 期慢性肾脏病。环孢素 A 谷浓度是回归模型中一个显著的时间依赖性因素，在模型中去除时间后，蛋白尿是最重要的因素。GFR 估计方法高估了实测 GFR；更新的 Schwartz 法为 11%，1987 年 Schwartz 法为 50%，Counahan-Barratt 法为 31%。