Gámán György, Gelley Fanni, Gerlei Zsuzsa, Dabasi Eszter, Görög Dénes, Fehérvári Imre, Kóbori László, Lengyel Gabriella, Zádori Gergely, Fazakas János, Doros Attila, Sárváry Enikő, Nemes Balázs
Transzplantációs és Sebészeti Klinika, Budapest.
Orv Hetil. 2013 Jun 30;154(26):1018-25. doi: 10.1556/OH.2013.29641.
In liver cirrhosis renal function decreases as well. Hepatorenal syndrome is the most frequent cause of the decrease, but primary kidney failure, diabetes mellitus and some diseases underlying endstage liver failure (such as hepatitis C virus infection) can also play an important role. In liver transplantation several further factors (total cross-clamping of vena cava inferior, polytransfusion, immunosuppression) impair the renal function, too.
The aim of this study was to analyse the changes in kidney function during the first postoperative year after liver transplantation.
Retrospective data analysis was performed after primary liver transplantations (n = 319).
impaired preoperative renal function increased the devepolment of postoperative complications and the first year cumulative patient survival was significantly worse (91,7% vs 69,9%; p<0,001) in this group. If renal function of the patients increased above 60 ml/min/1,73 m2 after the first year, patient survival was better. Independently of the preoperative kidney function, 76% of the patients had impaired kidney function at the first postoperative year. In this group, de novo diabetes mellitus was more frequently diagnosed (22,5% vs 9,5%; p = 0,023).
Selection of personalized immunosuppressive medication has a positive effect on renal function.
在肝硬化患者中，肾功能也会下降。肝肾综合征是肾功能下降最常见的原因，但原发性肾衰竭、糖尿病以及一些终末期肝衰竭的潜在疾病（如丙型肝炎病毒感染）也可能起重要作用。在肝移植过程中，还有其他一些因素（下腔静脉完全阻断、大量输血、免疫抑制）也会损害肾功能。
本研究旨在分析肝移植术后第一年肾功能的变化。
对初次肝移植患者（n = 319）进行回顾性数据分析。
术前肾功能受损会增加术后并发症的发生率，且该组患者术后第一年的累积生存率显著更低（91.7% 对 69.9%；p < 0.001）。如果患者术后第一年肾功能提高到60 ml/min/1.73 m² 以上，患者生存率更高。与术前肾功能无关，76% 的患者在术后第一年肾功能受损。在该组中，新发糖尿病的诊断更为频繁（22.5% 对 9.5%；p = 0.023）。
选择个性化免疫抑制药物对肾功能有积极影响。
