Key Lab of Combined Multi-Organ Transplantation, Key Lab of Organ Transplantation, Ministry of Public Health, Hangzhou 310003, Zhejiang Province, China.
World J Gastroenterol. 2012 Dec 21;18(47):7033-9. doi: 10.3748/wjg.v18.i47.7033.
To investigate the impact of renal and graft function on post-transplant hyperlipidemia (PTHL) in living donor liver transplantation (LDLT).
A total of 115 adult patients undergoing LDLT from January 2007 to May 2009 at a single center were enrolled. Data were collected and analyzed by the China Liver Transplant Registry retrospectively. PTHL was defined as serum triglycerides ≥ 150 mg/dL or serum cholesterol ≥ 200 mg/dL or the need for pharmacologic treatment at the sixth month after LDLT. Early renal dysfunction (ERD) was defined as serum creatinine ≥ 2 mg/dL and/or the need for renal replacement therapy in the first post-transplant week.
In 115 eligible patients, the incidence of PTHL was 24.3%. Recipients with PTHL showed a higher incidence of post-transplant cardiovascular events compared to those without PTHL (17.9% vs 4.6%, P = 0.037). Serum creatinine showed significant positive correlations with total serum triglycerides, both at post-transplant month 1 and 3 (P < 0.01). Patients with ERD had much higher pre-transplant serum creatinine levels (P < 0.001) and longer duration of pre-transplant renal insufficiency (P < 0.001) than those without ERD. Pre-transplant serum creatinine, graft-to-recipient weight ratio, graft volume/standard liver volume ratio, body mass index (BMI) and ERD were identified as risk factors for PTHL by univariate analysis. Furthermore, ERD [odds ratio (OR) = 9.593, P < 0.001] and BMI (OR = 6.358, P = 0.002) were identified as independent risk factors for PTHL by multivariate analysis.
Renal function is closely associated with the development of PTHL in LDLT. Post-transplant renal dysfunction, which mainly results from pre-transplant renal insufficiency, contributes to PTHL.
探讨活体肝移植（LDLT）中供体和受体的肾功能对移植后高脂血症（PTHL）的影响。
本研究共纳入了 2007 年 1 月至 2009 年 5 月期间在一家中心接受 LDLT 的 115 例成年患者。回顾性地从中国肝移植注册中心收集并分析了这些数据。PTHL 定义为血清甘油三酯≥150mg/dL 或血清胆固醇≥200mg/dL 或 LDLT 后第六个月需要药物治疗。早期肾功能不全（ERD）定义为移植后第一周血清肌酐≥2mg/dL 和/或需要肾脏替代治疗。
在 115 例合格患者中，PTHL 的发生率为 24.3%。与无 PTHL 患者相比，PTHL 患者移植后心血管事件的发生率更高（17.9% vs 4.6%，P=0.037）。移植后第 1 个月和第 3 个月，血清肌酐与总血清甘油三酯均呈显著正相关（P<0.01）。与无 ERD 患者相比，ERD 患者的术前血清肌酐水平更高（P<0.001），术前肾功能不全持续时间更长（P<0.001）。单因素分析显示，术前血清肌酐、供体与受体体重比、移植物体积/标准肝体积比、体重指数（BMI）和 ERD 是 PTHL 的危险因素。进一步的多因素分析显示，ERD（比值比[OR]=9.593，P<0.001）和 BMI（OR=6.358，P=0.002）是 PTHL 的独立危险因素。
肾功能与 LDLT 中 PTHL 的发生密切相关。移植后肾功能不全主要由术前肾功能不全引起，导致 PTHL。
