慢性肾脏病和急性肾损伤的发生是否会影响活体供肝肝移植后的预后？

Does the development of chronic kidney disease and acute kidney injury affect the prognosis after living donor liver transplantation?

作者信息

Inoue Yusuke, Soyama Akihiko, Takatsuki Mitsuhisa, Hidaka Masaaki, Kinoshita Ayaka, Natsuda Koji, Baimakhanov Zhassulan, Kugiyama Tota, Adachi Tomohiko, Kitasato Amane, Kuroki Tamotsu, Eguchi Susumu

机构信息

Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.

出版信息

Clin Transplant. 2016 May;30(5):518-27. doi: 10.1111/ctr.12715. Epub 2016 Mar 14.

DOI:10.1111/ctr.12715

PMID:26865166

Abstract

BACKGROUND AND AIMS

Chronic kidney disease (CKD) and acute kidney injury (AKI) have been discussed as complications following living donor liver transplantation (LDLT). The aim of this study was to clarify the relationships among CKD, AKI, and the prognosis after LDLT.

METHODS

This study included 118 patients who underwent LDLT in our department. A low eGFR (<60 mL/min/1.73 m(2) ) was regarded to indicate CKD. AKI 1 and AKI 2 were characterized by an increase in the serum creatinine level of 0.5 and 1.0 mg/dL, respectively, within one wk after LDLT. We investigated the risk factors for and the relevance of CKD and AKI on the prognosis.

RESULTS

AKI 1 was associated with sepsis and intra-operative bleeding (p = 0.0032, p = 0.001). AKI 2 was associated with sepsis and hepatitis C infection (p < 0.001, p = 0.027). A pre-operative eGFR of 60-89 and diabetes were the risk factors for the development of CKD in POY 2 (p = 0.018, p = 0.002). AKI 2, sepsis, and diabetes were the risk factors for the patient death within one yr after LDLT (p = 0.010, p = 0.002, p = 0.022). AKI 2 and sepsis were the risk factors for death within two yr after LDLT (p = 0.005, p = 0.018).

CONCLUSIONS

Recognizing the risk factors and careful management for preventing both AKI and CKD may improve the prognosis of patients following LDLT.

摘要

背景与目的

慢性肾脏病（CKD）和急性肾损伤（AKI）已被作为活体肝移植（LDLT）后的并发症进行讨论。本研究的目的是阐明CKD、AKI与LDLT后预后之间的关系。

方法

本研究纳入了在我科接受LDLT的118例患者。低估算肾小球滤过率（eGFR）（<60 mL/min/1.73 m²）被视为提示CKD。AKI 1和AKI 2分别以LDLT后1周内血清肌酐水平升高0.5和1.0 mg/dL为特征。我们调查了CKD和AKI的危险因素及其与预后的相关性。

结果

AKI 1与脓毒症和术中出血相关（p = 0.0032，p = 0.001）。AKI 2与脓毒症和丙型肝炎感染相关（p < 0.001，p = 0.027）。术前eGFR为60 - 89以及糖尿病是术后第2年发生CKD的危险因素（p = 0.018，p = 0.002）。AKI 2、脓毒症和糖尿病是LDLT后1年内患者死亡的危险因素（p = 0.010，p = 0.002，p = 0.022）。AKI 2和脓毒症是LDLT后2年内死亡的危险因素（p = 0.005，p = 0.018）。