Narciso Roberto C, Ferraz Leonardo R, Rodrigues Cassio J O, Monte Júlio C M, Mie Sérgio, Dos Santos Oscar F P, Paes Ângela T, Cendoroglo Miguel, Jaber Bertrand L, Durão Marcelino S, Batista Marcelo C
Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil.
Int J Artif Organs. 2013 Jul;36(7):498-505. doi: 10.5301/ijao.5000201. Epub 2013 May 20.
Patients undergoing orthotropic liver transplant (LTx) often present with chronic kidney disease (CKD). Identification of patients who will progress to end-stage renal disease (ESRD) might allow not only the implementation of kidney protective measures but also simultaneous kidney transplant.
Retrospective cohort study in adults who underwent LTx at a single center. ESRD, death, and composite of ESRD or death were studied outcomes.
331 patients, who underwent LTx, were followed up for 2.6 ± 1.4 years; 31 (10%) developed ESRD, 6 (2%) underwent kidney transplant after LTx and 25 (8%) remained on chronic hemodialysis. Patients with preoperative eGFR lesser than 60 ml/min per 1.73 m2 had a 4-fold increased risk of developing ESRD after adjustment for sex, diabetes mellitus, APACHE II score, use of nephrotoxic drugs, and severe liver graft failure (HR = 3.95, 95% CI 1.73, 9.01; p = 0.001). Other independent risk factors for ESRD were preoperative diabetes mellitus and post-operative severe liver graft dysfunction.
These findings emphasize low eGFR prior to LTx as a predictor for ESRD or death. The consideration for kidney after liver transplant as a treatment modality should be taken into account for those who develop chronic kidney failure after LTx.
接受原位肝移植（LTx）的患者常伴有慢性肾脏病（CKD）。识别可能进展为终末期肾病（ESRD）的患者，不仅有助于采取肾脏保护措施，还能考虑同期进行肾移植。
对在单一中心接受LTx的成人患者进行回顾性队列研究。研究结局包括ESRD、死亡以及ESRD或死亡的复合结局。
331例接受LTx的患者随访了2.6±1.4年；31例（10%）发生ESRD，6例（2%）在LTx后接受了肾移植，25例（8%）仍接受慢性血液透析。术前估算肾小球滤过率（eGFR）低于60 ml/min/1.73 m²的患者，在调整性别、糖尿病、急性生理与慢性健康状况评分系统II（APACHE II）评分、使用肾毒性药物以及严重肝移植失败等因素后，发生ESRD的风险增加4倍（风险比[HR]=3.95，95%置信区间[CI] 1.73，9.01；P=0.001）。ESRD的其他独立危险因素为术前糖尿病和术后严重肝移植功能障碍。
这些发现强调LTx术前低eGFR是ESRD或死亡的预测指标。对于LTx后发生慢性肾衰竭的患者，应考虑将肝移植后肾移植作为一种治疗方式。
