Liver Unit, Queen Elizabeth Hospital, Birmingham, UK; NIHR Biomedical Research Unit and Centre for Liver Research, University of Birmingham, Birmingham, UK.
Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.
J Hepatol. 2014 Jun;60(6):1180-6. doi: 10.1016/j.jhep.2014.02.019. Epub 2014 Mar 13.
BACKGROUND & AIMS: The growing discrepancy between supply and demand for liver transplantation has necessitated a greater use of higher risk grafts. Donation after Circulatory Death (DCD) liver transplant recipients have an increased frequency of acute kidney injury (AKI). We hypothesised that other higher risk grafts might also impact negatively on renal function. Our aim was to examine the effect of the evolving use of higher risk grafts on the incidence of post liver transplant AKI.
Single-centre study of 1152 patients undergoing first-single-organ liver transplantation for chronic liver disease 01/2000-12/2011. To assess the impact of the evolution of graft quality over time; donor/graft/recipient variables were compared over three 4-year periods.
Pretransplant recipient renal function improved during follow-up (p<0.001), and the median postoperative day-1 (p<0.001), -2 (p<0.001), and -3 (p<0.001) tacrolimus trough levels fell. The proportion of patients receiving a higher risk graft was 31.8% in 2000-2003, 40.9% in 2004-2007, and 59.1% in 2008-2011 (p<0.001). There was a progressive increase in AKI (2000-2003, OR 1.00; 2004-2007, OR 1.43; 2008-2011, OR 2.40, p<0.001). After adjusting for recipient variables increasing recipient warm ischaemic time (p=0.019), DCD transplantation (p<0.001), donor age ≥60 years (p=0.020), and donor body mass index ≥30 kg/m(2) (p<0.001) were independent predictors of AKI.
The increasing use of higher risk liver grafts is associated with an increased incidence of AKI. These findings support the need for therapies that minimise the hepatic ischaemia-reperfusion injury.
肝移植供体需求与供给之间的差距不断扩大，这使得更多使用高危供体成为必要。脑死亡供体（DCD）肝移植受者发生急性肾损伤（AKI）的频率更高。我们假设其他高危供体也可能对肾功能产生负面影响。我们的目的是研究不断使用高危供体对肝移植后 AKI 发生率的影响。
这是一项对 2000 年 1 月至 2011 年 12 月期间在单中心接受首次单器官肝移植的 1152 例慢性肝病患者进行的单中心研究。为了评估供体质量随时间演变的影响，在三个 4 年期间比较了供体/移植物/受者变量。
在随访期间，移植前受者的肾功能得到改善（p<0.001），术后第 1 天（p<0.001）、第 2 天（p<0.001）和第 3 天（p<0.001）的他克莫司谷浓度中位数下降。2000-2003 年、2004-2007 年和 2008-2011 年接受高危供体的患者比例分别为 31.8%、40.9%和 59.1%（p<0.001）。AKI 的发生率呈逐渐增加趋势（2000-2003 年，OR 1.00；2004-2007 年，OR 1.43；2008-2011 年，OR 2.40，p<0.001）。调整受者变量后，受者热缺血时间延长（p=0.019）、DCD 移植（p<0.001）、供者年龄≥60 岁（p=0.020）和供者体重指数≥30 kg/m2（p<0.001）是 AKI 的独立预测因素。
高危肝移植供体的使用不断增加与 AKI 发生率增加相关。这些发现支持需要治疗方法来最小化肝缺血再灌注损伤。
