Iwata H, Mizuno S, Ishikawa E, Tanemura A, Murata Y, Kuriyama N, Azumi Y, Kishiwada M, Usui M, Sakurai H, Tabata M, Yamamoto N, Sugimoto K, Shiraki K, Takei Y, Ito M, Isaji S
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University School of Medicine, Tsu, Mie, Japan.
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University School of Medicine, Tsu, Mie, Japan.
Transplant Proc. 2014 Apr;46(3):716-20. doi: 10.1016/j.transproceed.2013.11.113.
In deceased-donor liver transplantation settings, post-transplantation acute renal failure with the induction of renal replacement therapy (RRT) is known to have negative effects on graft and patient survivals. However, the impact of RRT in living-donor liver transplantation (LDLT) has not been well investigated. The aim of this study was to elucidate risk factors requiring RRT and prognostic factors after its induction.
Clinical data on the consecutive 113 adult patients who underwent LDLT from March 2002 to May 2013 were retrospectively reviewed. They were divided into 2 groups: RRT (n = 33) and Non-RRT (n = 80). The primary reasons for receiving RRT were hepatorenal syndrome (n = 17), sepsis (n = 12), and renal hypoperfusion (n = 4).
Although there were no significant differences in age or sex, the Model for End-Stage Liver Disease (MELD) score was significantly higher in the RRT group than in the Non-RRT group (23 ± 13 vs 16 ± 7; P = .002). The graft-recipient weight ratio (GRWR) was significantly lower in the RRT group (0.86 ± 0.3 vs 0.99 ± 0.2; P = .025). The 1- and 5-year patient survival rates were significantly higher in the Non-RRT group than in the RRT group (respectively, 91.3% and 84.3% vs 42.9% and 25.5%; P < .001). In multivariate analysis, independent risk factors for receiving RRT were MELD score >20 (P = .044) and GRWR <0.7 (P = .039). In the RRT group, donor age >50 years (P = .042) and preoperative serum creatinine level >1.5 mg/dL (P = .049) were significant prognostic risk factors.
In adult LDLT patients, the induction of RRT after LDLT was a negative predictor of survival. In addition to the preoperative recipient's condition, donor factors including graft size and donor age influenced prognosis after the induction of RRT.
在尸体供肝肝移植情况下，移植后急性肾衰竭并进行肾脏替代治疗（RRT）已知会对移植物和患者存活率产生负面影响。然而，RRT在活体供肝肝移植（LDLT）中的影响尚未得到充分研究。本研究的目的是阐明需要RRT的危险因素及其诱导后的预后因素。
回顾性分析2002年3月至2013年5月连续113例接受LDLT的成年患者的临床资料。他们被分为两组：RRT组（n = 33）和非RRT组（n = 80）。接受RRT的主要原因是肝肾综合征（n = 17）、败血症（n = 12）和肾灌注不足（n = 4）。
虽然年龄和性别无显著差异，但RRT组的终末期肝病模型（MELD）评分显著高于非RRT组（23±13 vs 16±7；P = .002）。RRT组的移植物-受者体重比（GRWR）显著更低（0.86±0.3 vs 0.99±0.2；P = .025）。非RRT组的1年和5年患者存活率显著高于RRT组（分别为91.3%和84.3% vs 42.9%和25.5%；P < .001）。多因素分析显示，接受RRT的独立危险因素为MELD评分>20（P = .044）和GRWR <0.7（P = .039）。在RRT组中，供体年龄>50岁（P = .042）和术前血清肌酐水平>1.5 mg/dL（P = .049）是显著的预后危险因素。
在成年LDLT患者中，LDLT后诱导RRT是生存的负性预测因素。除了术前受者的情况外，包括移植物大小和供体年龄在内的供体因素会影响RRT诱导后的预后。
