Aparici Carina Mari, Bains Sukhkarn N, Carlson David, Qian Jesse, Liou Douglas, Wojciechowski David, Werner Jacob, Khan Sana, Kroll Cameron, Sandhu Manreet, Nguyen Nhan, Hawkins Randall
Department of Radiology, Division of Nuclear Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA; Department of Radiology, Nuclear Medicine Division, San Francisco VAMC, San Francisco, California, USA.
Department of Radiology, Division of Nuclear Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA.
World J Nucl Med. 2016 Jan-Apr;15(1):44-9. doi: 10.4103/1450-1147.172140.
Many patients with hepatorenal syndrome (HRS) end up receiving a combined liver and kidney transplant (CKLT) with preservation of native kidneys, specially type 1 HRS since is characterizes by a very rapid deterioration of renal function. Eventually, most of the patients regain renal function, but it is unknown if this is due to the transplanted kidney, the recovery of native renal function, or both. The aim of this study is to evaluate if there is recovery of native renal function in patients with HRS following CKLT. 22 patients (16 men; 6 women) with history of HRS and status post CKLT were studied. Mercapto-acetyltriglycine-3 renograms in the anterior and posterior views with the three kidneys in the field of view were simultaneously acquired. The renograms were analyzed by creating regions of interest around the transplanted and native kidneys. Relative contribution to the renal function, clearance, and effective renal plasma flow for the transplanted and native kidneys were obtained. 1/22 (4.5%) patients presented with a very poor functioning transplanted kidney, in 15/22 (68%) cases the combined native renal function was markedly poorer than the transplanted renal function and in 6/22 (27%) native kidneys showed a contribution to the renal function similar to the transplanted kidney. In conclusion, our series show that around 32% of the HRS patients recovered their native renal function after CKLT. Identification of common factors that affect recovery of native renal function may help to avoid unnecessary renal transplants, significantly reducing morbidity and cost, while facilitating a reallocation of scarce donor resources.
许多肝肾综合征（HRS）患者最终接受了肝肾联合移植（CKLT），同时保留了自身肾脏，尤其是1型HRS患者，因为其肾功能会迅速恶化。最终，大多数患者恢复了肾功能，但尚不清楚这是由于移植肾、自身肾功能的恢复，还是两者共同作用的结果。本研究的目的是评估CKLT术后HRS患者的自身肾功能是否恢复。对22例有HRS病史且已接受CKLT的患者（16例男性；6例女性）进行了研究。同时采集了前位和后位的巯基乙酰三甘氨酸-3肾图，视野中包含三个肾脏。通过在移植肾和自身肾周围创建感兴趣区域来分析肾图。获得了移植肾和自身肾对肾功能、清除率及有效肾血浆流量的相对贡献。22例患者中有1例（4.5%）移植肾功能极差，22例中有15例（68%）自身肾功能明显差于移植肾功能，22例中有6例（27%）自身肾对肾功能的贡献与移植肾相似。总之，我们的系列研究表明，约32%的HRS患者在CKLT术后恢复了自身肾功能。识别影响自身肾功能恢复的常见因素可能有助于避免不必要的肾移植，显著降低发病率和成本，同时有助于重新分配稀缺的供体资源。
