终末期肝病合并未接受透析治疗的肾功能不全患者的肝肾联合移植与单纯肝移植对比研究
Simultaneous liver-kidney versus liver transplantation alone in patients with end-stage liver disease and kidney dysfunction not on dialysis.
作者信息
Mindikoglu A L, Raufman J P, Seliger S L, Howell C D, Magder L S
机构信息
Department of Medicine, Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
出版信息
Transplant Proc. 2011 Sep;43(7):2669-77. doi: 10.1016/j.transproceed.2011.07.002.
BACKGROUND
Since implementation of the Model for End-stage Liver Disease (MELD), the number of simultaneous liver-kidney transplantations (SLKT) has increased in the United States. However, predictors and survival benefit of SLKT compared to liver transplantation alone (LTA) are not well defined.
METHODS
Organ Procurement and Transplantation Network data of patients with end-stage liver disease (ESLD) with estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2) who had not been on dialysis while on the waiting list and underwent liver transplantation between 2002 and 2008 were analyzed. To identify predictors of undergoing SLKT versus LTA, multiple logistic regression analysis was performed. Cox proportional hazards regression analysis was used to assess the association between SLKT and post-liver transplant patient and graft survival.
RESULTS
The study cohort comprised 5443 patients; 262 (5%) underwent SLKT and 5181 (95%) underwent LTA. Adjusting for potential confounders, patients who underwent SLKT were 34% less likely to die after liver transplantation than those who underwent LTA (hazard ratio [HR] = 0.66, P = .012) and 33% less likely to have liver graft failure than those who underwent LTA (HR = 0.67, P = .010). Among those who underwent SLKT, 1-, 3-, and 5-year kidney graft survival probabilities were 88%, 80%, and 77%, respectively. Black race and diabetes were associated with a higher likelihood of SLKT versus LTA; female sex, a higher eGFR, and higher MELD score reduced the likelihood of SLKT.
CONCLUSIONS
Among those with ESLD and kidney dysfunction not on dialysis, post-liver transplant patient and liver graft survivals of patients who underwent SLKT were superior to those of patients who underwent LTA. Whether this reflects differences in the two groups that could not be adjusted in survival models or a specific effect of kidney dysfunction cannot be established.
背景
自终末期肝病模型（MELD）实施以来，美国肝肾联合移植（SLKT）的数量有所增加。然而，与单纯肝移植（LTA）相比，SLKT的预测因素和生存获益尚未明确界定。
方法
分析了器官获取与移植网络中2002年至2008年间终末期肝病（ESLD）且估计肾小球滤过率（eGFR）<60 mL/min/1.73 m²、在等待名单上未接受透析且接受肝移植患者的数据。为确定接受SLKT与LTA的预测因素，进行了多因素逻辑回归分析。采用Cox比例风险回归分析评估SLKT与肝移植后患者及移植物存活之间的关联。
结果
研究队列包括5443例患者；262例（5%）接受了SLKT，5181例（95%）接受了LTA。在调整潜在混杂因素后，接受SLKT的患者肝移植后死亡的可能性比接受LTA的患者低34%（风险比[HR]=0.66，P=0.012），发生肝移植失败的可能性比接受LTA的患者低33%（HR=0.67，P=0.010）。在接受SLKT的患者中，1年、3年和5年肾移植存活概率分别为88%、80%和77%。黑人种族和糖尿病与接受SLKT而非LTA的可能性较高相关；女性、较高的eGFR和较高的MELD评分降低了接受SLKT的可能性。
结论
在未接受透析的ESLD和肾功能不全患者中，接受SLKT的患者肝移植后患者及肝移植物存活率优于接受LTA的患者。这是否反映了生存模型中无法调整的两组差异或肾功能不全的特定影响尚无法确定。
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