肝移植后的长期并发症

Long-term complications after liver transplantation.

作者信息

Kuramitsu K, Fukumoto T, Iwasaki T, Tominaga M, Matsumoto I, Ajiki T, Ku Y

机构信息

Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Japan.

出版信息

Transplant Proc. 2014 Apr;46(3):797-803. doi: 10.1016/j.transproceed.2013.11.047.

DOI:10.1016/j.transproceed.2013.11.047

PMID:24767352

Abstract

BACKGROUND

Along with an increased number of cases of liver transplantation (LT), perioperative mortality has decreased and short-term survival has improved. However, long-term complications have not been fully elucidated today.

PURPOSE

Chronic complications were analyzed individually to find risk factors and to improve long-term outcomes after LT.

SUBJECTS

There were 63 cases of LT from our outpatient clinic that were included in this study. Among them, 58 were performed using living donor LT and 5 were performed using deceased donor LT. Original diseases mainly consisted of hepatitis C virus (HCV; 45.9%) and hepatitis B virus (23.0%).

FINDINGS

The median follow-up was 5.4 ± 3.3 years (range, 0.1∼17 years). Overall survival at 2, 3, 5, and 10 years was 89.3%, 83.4%, 81.3%, and 81.3%, respectively. Long-term complications mainly consisted of renal dysfunction (62.7%), dyslipidemia (29.4%), diabetes mellitus (21.6%), and arterial hypertension (21.6%). In univariate analysis, HCV (P = .03) and elapsed years after LT (P = .02) were identified as predictive factors for arterial hypertension and recipient age >50 (P = .03), and elapsed years after LT for renal dysfunction (P = .03), respectively. In multivariate Cox regression analysis, HCV (odds ratio [OR] 5.25, 95% confidence interval [CI] 1.05-34.06, P = .04) was identified as a predictive factor for arterial hypertension, and recipient age older than 50 years for renal dysfunction (OR 5.67, 95% CI 1.34-28.88, P = .02). The number of elapsed years after transplantation was also identified as a predictive factor for arterial hypertension/dyslipidemia/renal dysfunction (OR 13.88/14.15/4.10, 95% CI 1.91-298.26/2.18-290.78/1.09-18.03, P = .01/.003/.04). Fifty percent of the recipients developed renal dysfunction within 8 years after LT, and fluctuation of estimated glomerular filtration rate (eGFR) within 3 months after LT was successfully associated with an annual decrease of eGFR (r(2) value = 0.574, P < .0001).

CONCLUSION

Renal dysfunction is the most frequent chronic complication after LT. As chronic individual eGFR can be now accurately predicted with deterioration speed, recipient strata for renal protection strategies should be precisely targeted.

摘要

背景

随着肝移植（LT）病例数的增加，围手术期死亡率有所下降，短期生存率得到改善。然而，长期并发症至今尚未完全阐明。

目的

对慢性并发症进行个体分析，以寻找危险因素并改善肝移植后的长期结局。

对象

本研究纳入了我们门诊的63例肝移植病例。其中，58例采用活体供肝肝移植，5例采用尸体供肝肝移植。原发病主要包括丙型肝炎病毒（HCV；45.9%）和乙型肝炎病毒（23.0%）。

结果

中位随访时间为5.4±3.3年（范围0.1至17年）。2年、3年、5年和10年的总生存率分别为89.3%、83.4%、81.3%和81.3%。长期并发症主要包括肾功能不全（62.7%）、血脂异常（29.4%）、糖尿病（21.6%）和动脉高血压（21.6%）。单因素分析中，HCV（P = 0.03）和肝移植后的时间（P = 0.02）分别被确定为动脉高血压和受体年龄>50岁（P = 0.03）以及肝移植后时间与肾功能不全（P = 0.03）的预测因素。多因素Cox回归分析中，HCV（比值比[OR] 5.25，95%置信区间[CI] 1.05 - 34.06，P = 0.04）被确定为动脉高血压的预测因素，受体年龄大于50岁是肾功能不全的预测因素（OR 5.67，95% CI 1.34 - 28.88，P = 0.02）。移植后的时间也被确定为动脉高血压/血脂异常/肾功能不全的预测因素（OR 13.88/14.15/4.10，95% CI 1.91 - 298.26/2.18 - 290.78/1.09 - 18.03，P = 0.01/0.003/0.04）。50%的受者在肝移植后8年内出现肾功能不全，肝移植后3个月内估计肾小球滤过率（eGFR）的波动与eGFR的年度下降成功相关（r²值 = 0.574，P < 0.0001）。