Matsui T, Usui M, Fujinaga K, Nakatani K, Iizawa Y, Kato H, Tanemura A, Murata Y, Azumi Y, Kuriyama N, Kishiwada M, Mizuno S, Sakurai H, Isaji S
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Mie, Japan.
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Mie, Japan.
Transplant Proc. 2016 May;48(4):1184-9. doi: 10.1016/j.transproceed.2016.02.014.
Late renal dysfunction (LRD) is known to be one of the most important complications to affect long-term outcome after living-donor liver transplantation (LDLT). The relationship between angiotensin-converting enzyme insertion (I)/deletion (D) gene polymorphism and renal function after LDLT are still unknown. The aim of this study was to elucidate the risk factors for LRD after LDLT, focusing on ACE gene polymorphism.
Among the 94 recipients who underwent adult-to-adult LDLT between March 2002 and September 2009, the total number of subjects who survived more than 1 year after LDLT and in whom angiotensin-converting enzyme genotype could be measured was 64. LRD was defined as estimated glomerular filtration rate level less than 60 mL/min/1.73 m(2) at any point after 1 year from undergoing LDLT.
LRD was found in 24 patients (37.5%). The incidence of LRD was significantly higher in D/D type than in I/I or I/D type: 85.7% (6/7) vs. 42.1% (8/19), 35.7% (10/38) (P = .010). Preoperative estimated glomerular filtration rate was significantly lower in D/D type than in I/I, I/D types, and postoperatively they were significantly lower in D/D type at 2, 3, and 4 years after LDLT. By multivariate analysis, age and hypertension were the independent risk factors for LRD. The 10-year survival rate was much lower in the recipients with LRD than in those without LRD at 66.7% versus 87.5%, respectively (P = .053).
In conclusion, age and hypertension were determined as significant independent risk factors for LRD after adult-to-adult LDLT, and the recipients with D/D genotype should be strictly cared for the development of LRD.
晚期肾功能障碍（LRD）是活体肝移植（LDLT）后影响长期预后的最重要并发症之一。血管紧张素转换酶插入（I）/缺失（D）基因多态性与LDLT后肾功能之间的关系尚不清楚。本研究的目的是阐明LDLT后LRD的危险因素，重点关注ACE基因多态性。
在2002年3月至2009年9月期间接受成人对成人LDLT的94例受者中，LDLT后存活超过1年且可测量血管紧张素转换酶基因型的受试者总数为64例。LRD定义为LDLT术后1年任何时间点估计肾小球滤过率水平低于60 mL/min/1.73 m²。
24例患者（37.5%）出现LRD。D/D型LRD的发生率显著高于I/I型或I/D型：85.7%（6/7）对42.1%（8/19），35.7%（10/38）（P = 0.010）。术前估计肾小球滤过率D/D型显著低于I/I型、I/D型，术后LDLT后2、3、4年D/D型也显著降低。多因素分析显示，年龄和高血压是LRD的独立危险因素。有LRD的受者10年生存率远低于无LRD的受者，分别为66.7%和87.5%（P = 0.053）。
总之，年龄和高血压被确定为成人对成人LDLT后LRD的重要独立危险因素，D/D基因型的受者应严格关注LRD的发生。
