Fujinaga K, Usui M, Yamamoto N, Ishikawa E, Nakatani A, Kishiwada M, Mizuno S, Sakurai H, Tabata M, Isaji S
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
Transplant Proc. 2014 Apr;46(3):804-10. doi: 10.1016/j.transproceed.2013.11.103.
Late renal dysfunction (LRD) after liver transplantation develops due to several factors such as viral hepatitis, calcineurin inhibitor, diabetes mellitus, and hypertension. The aim of our study was to clarify the risk factors for LRD after living donor liver plantation (LDLT) by using simple criteria for LRD and paying special attention to the significance of renal biopsy.
Among the 98 recipients undergoing LDLT between March 2002 and June 2008, there were 77 patients who survived more than 1 year and had been followed at our clinic. LRD was simply defined as a postoperative serum creatinine level of 1.5/L or more at any point in time after 1 year from undergoing LDLT. The perioperative risk factors for developing LRD after LDLT were analyzed by uni- and multivariate analyses, and regardless of serum creatinine level, a renal biopsy was indicated when the patient developed clinical symptoms.
Comparing the risk factors between 22 patients with LRD and 55 without LRD, univariate analysis revealed recipient's age, generation, hypertension, hepatitis C virus (HCV) antibody-positive, pretransplantation serum creatinine level, and graft-to-recipient weight ratio to be significant risk factors. By multivariate analysis, HCV and hypertension were selected as independent risk factors. Renal biopsy was indicated in the 4 patients with proteinuria, all of whom were positive for HCV. However, by histologic and/or electron micrographic analyses, only 1 patient was diagnosed with HCV-related membranous proliferative nephritis, 1 with diabetic nephropathy, and 2 with drug (tacrolimus) -induced renal dysfunction.
Although HCV and hypertension were determined to be independent risk factors for LRD after LDLT, a renal biopsy should be performed when clinical symptoms develop regardless of creatinine levels to provide appropriate treatment.
肝移植术后晚期肾功能不全（LRD）的发生是由多种因素引起的，如病毒性肝炎、钙调神经磷酸酶抑制剂、糖尿病和高血压。我们研究的目的是通过使用LRD的简单标准并特别关注肾活检的意义，来阐明活体肝移植（LDLT）后LRD的危险因素。
在2002年3月至2008年6月期间接受LDLT的98例受者中，有77例存活超过1年并在我们诊所接受随访。LRD被简单定义为LDLT术后1年任何时间点血清肌酐水平达到1.5mg/dL或更高。通过单因素和多因素分析对LDLT术后发生LRD的围手术期危险因素进行分析，并且无论血清肌酐水平如何，当患者出现临床症状时均进行肾活检。
比较22例LRD患者和55例无LRD患者的危险因素，单因素分析显示受者年龄、代次、高血压、丙型肝炎病毒（HCV）抗体阳性、移植前血清肌酐水平以及移植物与受者体重比是显著危险因素。通过多因素分析，HCV和高血压被选为独立危险因素。4例蛋白尿患者接受了肾活检，所有患者HCV均为阳性。然而，通过组织学和/或电子显微镜分析，仅1例患者被诊断为HCV相关的膜增生性肾炎，1例为糖尿病肾病，2例为药物（他克莫司）引起的肾功能不全。
虽然HCV和高血压被确定为LDLT术后LRD的独立危险因素，但无论肌酐水平如何，当出现临床症状时均应进行肾活检以提供适当的治疗。
