Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Transpl Int. 2013 Aug;26(8):842-52. doi: 10.1111/tri.12138.
Acute renal injury (ARI) is a serious complication after liver transplantation. This study investigated the usefulness of the RIFLE criteria in living donor liver transplantation (LDLT) and the prognostic impact of ARI after LDLT. We analyzed 200 consecutive adult LDLT patients, categorized as risk (R), injury (I), or failure (F), according to the RIFLE criteria. ARI occurred in 60.5% of patients: R-class, 23.5%; I-class, 21%; and F-class, 16%. Four patients in Group-A (normal renal function and R-class) and 26 patients in Group-B (severe ARI: I- and F-class) required renal replacement therapy (P < 0.001). Mild ARI did not affect postoperative prognosis regarding hospital mortality rate in Group A (3.2%), which was superior to that in Group B (15.8%; P = 0.0015). Fourteen patients in Group B developed chronic kidney disease (KDIGO stage 3/4). The 1-, 5- and 10-year survival rates were 96.7%, 90.6%, and 88.1% for Group A and 71.1%, 65.9%, and 59.3% for Group B, respectively (P < 0.0001). Multivariate analysis revealed risk factors for severe ARI as MELD ≥ 20 [odds ratio (OR) 2.9], small-for-size graft (GW/RBW <0.7%; OR 3.1), blood loss/body weight >55 ml/kg (OR 3.7), overexposure to calcineurin inhibitor (OR 2.5), and preoperative diabetes mellitus (OR 3.2). The RIFLE criteria offer a useful predictive tool after LDLT. Severe ARI, defined beyond class-I, could have negative prognostic impact in the acute and late postoperative phases. Perioperative treatment strategies should be designed and balanced based on the risk factors for the further improvement of transplant prognosis.
急性肾损伤（ARI）是肝移植后的严重并发症。本研究探讨了 RIFLE 标准在活体肝移植（LDLT）中的应用价值，以及 ARI 对 LDLT 后预后的影响。我们分析了 200 例连续的成人 LDLT 患者，根据 RIFLE 标准分为风险（R）、损伤（I）或衰竭（F）组。60.5%的患者发生 ARI：R 组 23.5%，I 组 21%，F 组 16%。A 组（肾功能正常和 R 级）4 例和 B 组（严重 ARI：I 级和 F 级）26 例患者需要肾脏替代治疗（P<0.001）。轻度 ARI 并未影响 A 组（3.2%）的术后住院死亡率，优于 B 组（15.8%；P=0.0015）。B 组 14 例患者发展为慢性肾脏病（KDIGO 分期 3/4）。A 组 1、5 和 10 年生存率分别为 96.7%、90.6%和 88.1%，B 组分别为 71.1%、65.9%和 59.3%（P<0.0001）。多因素分析显示，严重 ARI 的危险因素为 MELD≥20[比值比（OR）2.9]、小供肝/体质量比（GW/RBW<0.7%；OR 3.1）、出血量/体质量>55ml/kg（OR 3.7）、过度暴露于钙调磷酸酶抑制剂（OR 2.5）和术前糖尿病（OR 3.2）。RIFLE 标准为 LDLT 后提供了一种有用的预测工具。严重 ARI（超过 I 级）在急性和术后晚期可能有不良预后影响。应根据危险因素设计和平衡围手术期治疗策略，以进一步改善移植预后。
