Umbro I, Tinti F, Mordenti M, Rossi M, Ianni S, Pugliese F, Ruberto F, Ginanni Corradini S, Nofroni I, Poli L, Berloco P B, Mitterhofer A P
Department of Clinical Medicine, Nephrology and Dialysis Unit, Sapienza University of Rome, Rome, Italy.
Transplant Proc. 2011 May;43(4):1139-41. doi: 10.1016/j.transproceed.2011.02.045.
Hepatic function and renal failure are closely related among patients with end-stage liver disease (ESLD) due to splanchnic hemodynamic mechanisms that characterize advanced decompensated cirrhosis. Acute renal failure (ARF) is a frequent complication that occurs immediately post-orthotopic liver transplantation (OLT). The Model for End-stage Liver Disease (MELD) score describes the survival of patients with ESLD awaiting OLT related to the severity of liver disease. The Simplified Acute Physiology Score (SAPS II) is a mortality prediction model that scores the severity of illness among intensive care unit patients. In a previous study we observed an association between ARF post-OLT and a higher MELD score, but it was not clear whether this association depends on the grade of ESLD or on the critical condition of liver transplant patients. The aim of this study was to evaluate the association of ARF with MELD score and/or SAPS II criteria among liver transplant patients. We analyzed 46 patients with ESLD who underwent deceased donor OLT. All patients were evaluated at baseline and in the first 7 days post-OLT. According to the RIFLE classification, the incidence of the worst grade of ARF post-OLT was 19.2%. These patients showed significantly higher MELD scores, while there was no association with systemic parameters related to the critical patient's condition or with the mortality score as evaluated by SAPS II criteria. We confirmed the association between renal failure and hepatic function among liver transplant patients. A more severe degree of hepatic dysfunction before OLT was associated with a greater incidence of ARF that can adversely affect patient survival.
由于晚期失代偿性肝硬化的内脏血流动力学机制，终末期肝病（ESLD）患者的肝功能与肾衰竭密切相关。急性肾衰竭（ARF）是原位肝移植（OLT）后立即出现的常见并发症。终末期肝病模型（MELD）评分描述了等待OLT的ESLD患者与肝病严重程度相关的生存率。简化急性生理学评分（SAPS II）是一种死亡率预测模型，用于对重症监护病房患者的疾病严重程度进行评分。在之前的一项研究中，我们观察到OLT后ARF与较高的MELD评分之间存在关联，但尚不清楚这种关联是取决于ESLD的分级还是肝移植患者的危急状况。本研究的目的是评估肝移植患者中ARF与MELD评分和/或SAPS II标准之间的关联。我们分析了46例接受已故供体OLT的ESLD患者。所有患者在基线时以及OLT后的前7天进行评估。根据RIFLE分类，OLT后最严重等级的ARF发生率为19.2%。这些患者的MELD评分显著更高，而与危急患者状况相关的全身参数或SAPS II标准评估的死亡率评分之间没有关联。我们证实了肝移植患者中肾衰竭与肝功能之间的关联。OLT前更严重程度的肝功能障碍与更高的ARF发生率相关，这可能对患者生存产生不利影响。
