Umbro I, Tinti F, Piselli P, Fiacco F, Giannelli V, Di Natale V, Zavatto A, Merli M, Rossi M, Ginanni Corradini S, Poli L, Berloco P B, Mitterhofer A P
Department of Clinical Medicine, Nephrology and Dialysis Unit, Sapienza University of Rome, Rome, Italy.
Transplant Proc. 2012 Sep;44(7):1956-9. doi: 10.1016/j.transproceed.2012.06.012.
The aim of our study was to evaluate the occurrence of middle and long-term chronic renal failure (CRF) after orthotopic liver transplantation (OLT) in relation to acute renal failure (ARF). We prospectively monitored 75 patients, studying renal function on the basis of serum creatinine and glomerular filtration rate as estimated using the Modification of Diet in Renal Disease formula before as well as 1,6, and 12 months after OLT. The prevalence of ARF was 56% classified by the Acute Kidney injury Network criteria (52% stage 1, 29% stage 2, and 19% stage 3). The occurrences of CRF were 18.6% (11/59), 11.5% (6/52), and 14% (6/43) at 1, 6, and 12 months after OLT, respectively. The occurrence of CRF before OLT was 14.7%. We did not find any association between ARF and post-OLT CRF. The most relevant result of our study was the association between CRF at 6 and 12 months after transplantation with pre-OLT CRF on univariate and multivariate analysis. We suggest that evaluation of pre-OLT renal function should always be considered in the follow-up of liver transplant patients. Pre-OLT renal dysfunction must be recognized to be a risk factor for post-OLT CRF, representing important criterion to define specific therapeutic interventions to reduce patient morbidity and mortality.
我们研究的目的是评估原位肝移植（OLT）后中长期慢性肾衰竭（CRF）的发生情况及其与急性肾衰竭（ARF）的关系。我们前瞻性地监测了75例患者，根据血清肌酐以及使用肾脏病饮食改良公式估算的肾小球滤过率，在OLT前以及OLT后1、6和12个月对肾功能进行研究。根据急性肾损伤网络标准，ARF的患病率为56%（1期52%，2期29%，3期19%）。OLT后1、6和12个月时CRF的发生率分别为18.6%（11/59）、11.5%（6/52）和14%（6/43）。OLT前CRF的发生率为14.7%。我们未发现ARF与OLT后CRF之间存在任何关联。我们研究最相关的结果是，在单因素和多因素分析中，移植后6个月和12个月时的CRF与OLT前CRF之间存在关联。我们建议，在肝移植患者的随访中应始终考虑对OLT前肾功能进行评估。必须认识到OLT前肾功能不全是OLT后CRF的一个危险因素，这是定义特定治疗干预措施以降低患者发病率和死亡率的重要标准。
