Department of Medicine, University of Wisconsin, H4/564 CSC, 600 Highland Avenue, Madison, WI 53792, USA.
Clin J Am Soc Nephrol. 2011 Aug;6(8):1851-7. doi: 10.2215/CJN.00650111. Epub 2011 Jul 22.
There is little information on chronic kidney disease (CKD) stage progression rates and outcomes in liver transplant recipients. Identifying modifiable risk factors may help prevent CKD progression in liver transplant recipients.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We performed a retrospective review of 1151 adult, deceased-donor, single-organ primary liver transplants between July 1984 and December 2007 and analyzed kidney outcomes and risk factors for CKD stage progression. Seven hundred twenty-nine patients had an available estimated GFR at 1 year posttransplant to establish a baseline stage. The primary end point was the CKD progression from one stage to a higher stage (lower GFR).
Kaplan-Meier estimates of patient survival were 91%, 74%, and 64% at 5, 10, and 15 years, respectively. Estimates of liver allograft survival were 89%, 71%, and 60% at the same time points. At 1 year, 7%, 34%, 56%, 3%, and 1% of patients were in CKD stages 1, 2, 3, 4, and 5. The incidence of stage progression was 28%, 40%, and 53% at 3, 5, and 10 years. The incidence of ESRD was 2.6%, 7.5%, and 18% at 5, 10, and 20 years. Multivariable Cox regression analyses demonstrated that CKD stage at 1 year, pretransplant diabetes and urinary tract infections/hypercholesterolemia in the first year proved to be independent risk factors for stage progression (hazard ratio 1.9, 0.28, 1.39, and 1.46, respectively, P < 0.05).
Future studies will determine whether treatment of risk factors in the first posttransplant year prevent CKD progression in liver transplant recipients.
关于慢性肾脏病（CKD）阶段进展率和肝移植受者结局的信息很少。确定可改变的危险因素可能有助于预防肝移植受者 CKD 的进展。
设计、地点、参与者和测量：我们对 1984 年 7 月至 2007 年 12 月期间 1151 例成人、已故供体、单一器官原发性肝移植进行了回顾性研究，并分析了肾脏结局和 CKD 阶段进展的危险因素。729 例患者在移植后 1 年有可获得的估计肾小球滤过率（eGFR）以建立基线阶段。主要终点是 CKD 从一个阶段进展到更高阶段（较低的 eGFR）。
患者的Kaplan-Meier生存估计值分别为移植后 5、10 和 15 年的 91%、74%和 64%。肝移植的生存估计值分别为同一时间点的 89%、71%和 60%。在 1 年时，7%、34%、56%、3%和 1%的患者分别处于 CKD 1、2、3、4 和 5 期。在 3、5 和 10 年时，分期进展的发生率分别为 28%、40%和 53%。ESRD 的发生率分别为 5、10 和 20 年的 2.6%、7.5%和 18%。多变量 Cox 回归分析表明，1 年时的 CKD 分期、移植前糖尿病以及第 1 年的尿路感染/高胆固醇血症是分期进展的独立危险因素（危险比分别为 1.9、0.28、1.39 和 1.46，P <0.05）。
未来的研究将确定在移植后第 1 年治疗危险因素是否能预防肝移植受者的 CKD 进展。
