Fussner Lynn A, Charlton Michael R, Heimbach Julie K, Fan Chun, Dierkhising Ross, Coss Elizabeth, Watt Kymberly D
Department of Internal Medicine, Mayo Clinic Transplant Center, Rochester, MN, USA.
Liver Int. 2014 Sep;34(8):1259-66. doi: 10.1111/liv.12381. Epub 2013 Nov 21.
BACKGROUND & AIMS: Chronic kidney disease (CKD) after liver transplant (LT) is associated with increased long-term mortality. The impact of gender on CKD before and after LT is unknown. To further define risk factors and analyse gender differences in the incidence and progression of CKD after liver transplant.
Four hundred and fifty-five consecutive adult primary solitary LT recipients were included. Iothalamate clearance tests performed over time were analysed.
Mean age was 51.4 ± 10.4 years with 63% males. A percentage of 29.1% of females and 21.1% of males had a GFR<60 ml/min/1.73 m(2) and 10.2% of females and 5.9% of males had GFR<30 ml/min/1.73 m(2) prior to transplant. At 1 year, 52.6% of recipients tested (69.6% females, 43.0% males) had GFR<60 ml/min/1.73 m(2) and 7.3% (11.6% females, 4.9% males) had GFR<30 ml/min/1.73 m(2) . Pre-LT GFR<60 ml/min/1.73 m(2) [OR 3.28, (1.76-6.10), P ≤ 0.001], female gender (OR 2.96, (1.72-5.10), P < 0.001) and age [OR 1.09, (1.05-1.12), P < 0.001] were independently predictive of stage ≥3 CKD at 1 year post-LT. Female gender [OR 2.52, (1.25-4.71), P = 0.004], age [OR 1.05, (1.02-1.08), P = 0.003] and NASH [OR 2.95, (1.06-8.21), P = 0.039] were independently predictive of ≥stage 3 CKD at 5 years post-LT. Pre-LT diabetes was associated with stage 4 CKD at 5 years [OR 2.91, (1.33-6.36), P = 0.008] post-LT.
In addition to age and pre-LT CKD, female gender and NASH are independent predictors of ≥stage 3 CKD post-LT. Gender-based approaches to optimize modifiable risk factors are needed to improved post-transplant renal function.
肝移植（LT）后慢性肾脏病（CKD）与长期死亡率增加相关。性别对LT前后CKD的影响尚不清楚。为进一步明确肝移植后CKD发生和进展的危险因素并分析性别差异。
纳入455例连续的成年原发性孤立肝移植受者。对随时间进行的碘他拉酸盐清除试验进行分析。
平均年龄为51.4±10.4岁，男性占63%。移植前，29.1%的女性和21.1%的男性肾小球滤过率（GFR）<60 ml/min/1.73 m²，10.2%的女性和5.9%的男性GFR<30 ml/min/1.73 m²。1年时，接受检测的受者中52.6%（女性为69.6%，男性为43.0%）GFR<60 ml/min/1.73 m²，7.3%（女性为11.6%，男性为4.9%）GFR<30 ml/min/1.73 m²。肝移植前GFR<60 ml/min/1.73 m²[比值比（OR）3.28，（1.76 - 6.10），P≤0.001]、女性性别（OR 2.96，（1.72 - 5.10），P<0.001）和年龄[OR 1.09，（1.05 - 1.12），P<0.001]是肝移植后1年≥3期CKD的独立预测因素。女性性别[OR 2.52，（1.25 - 4.71），P = 0.004]、年龄[OR 1.05，（1.02 - 1.08），P = 0.003]和非酒精性脂肪性肝炎（NASH）[OR 2.95，（1.06 - 8.21），P = 0.039]是肝移植后5年≥3期CKD的独立预测因素。肝移植前糖尿病与肝移植后5年4期CKD相关[OR 2.91，（1.33 - 6.36），P = 0.008]。
除年龄和肝移植前CKD外，女性性别和NASH是肝移植后≥3期CKD的独立预测因素。需要基于性别的方法来优化可改变的危险因素，以改善移植后肾功能。
