Okamura Yusuke, Hata Koichiro, Inamoto Osamu, Kubota Toyonari, Hirao Hirofumi, Tanaka Hirokazu, Fujimoto Yasuhiro, Ogawa Kohei, Mori Akira, Okajima Hideaki, Kaido Toshimi, Uemoto Shinji
Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Hepatol Res. 2017 Apr;47(5):425-434. doi: 10.1111/hepr.12764. Epub 2016 Jul 19.
Liver transplantation is the only curative treatment for hepatorenal syndrome (HRS); however, the influence of HRS on the patient and renal outcome after living donor liver transplantation (LDLT) is still unclear. The aim of the present study was to evaluate the influence of HRS on the outcome of LDLT.
We retrospectively analyzed 357 consecutive adult patients who underwent primary LDLT between January 2005 and March 2013 at Kyoto University Hospital. The outcome of the patients with HRS was compared with those without HRS.
A total of 29 patients (8%) were diagnosed as HRS (Group-HRS) preoperatively, and the other 328 patients (92%) were not diagnosed as HRS (Group-Non-HRS). Group-HRS showed a significantly lower preoperative estimated glomerular filtration rate (22.1 vs 78.3 mL/min/1.73m , P < 0.001) and higher Child-Pugh-Turcotte score (13 vs 10, P < 0.001) than Group-non-HRS. After a median follow up of 60 months, the 1-, 3- and 5-year recipients' survival were 60.7%, 57.1% and 57.1% in Group-HRS, and 83.7%, 79.4% and 76.2% in Group-Non-HRS, respectively (P = 0.030). Concomitant HRS significantly elongated postoperative hospital stays (75 vs 50 days, P = 0.003), as well as predisposed patients to higher in-hospital mortality (41% vs 18%, P = 0.005). Multivariate analysis showed that preoperative renal dysfunction (estimated glomerular filtration rate on admission <40 mL/min/1.73m , OR 2.106, P = 0.03) was an independent risk factor for 1-year recipients' survival after LDLT, in addition to donor age ≥38 years (OR 3.114, P < 0.001), Child-Pugh-Turcotte score ≥13 (OR 2.929, P < 0.001) and left lobe graft (OR 2.225, P = 0.004).
Coincidence of HRS is associated with significantly worse outcome after LDLT, especially in the early post-transplant period.
肝移植是肝肾综合征（HRS）的唯一治愈性治疗方法；然而，HRS对活体供肝移植（LDLT）后患者及肾脏预后的影响仍不明确。本研究的目的是评估HRS对LDLT预后的影响。
我们回顾性分析了2005年1月至2013年3月在京都大学医院连续接受初次LDLT的357例成年患者。将HRS患者的预后与非HRS患者进行比较。
共有29例患者（8%）术前被诊断为HRS（HRS组），另外328例患者（92%）未被诊断为HRS（非HRS组）。HRS组术前估计肾小球滤过率显著低于非HRS组（22.1对78.3 mL/min/1.73m²，P＜0.001），Child-Pugh-Turcotte评分更高（13对10，P＜0.001）。中位随访60个月后，HRS组1年、3年和5年受者生存率分别为60.7%、57.1%和57.1%，非HRS组分别为83.7%、79.4%和76.2%（P = 0.030）。合并HRS显著延长术后住院时间（75对50天，P = 0.003），并使患者院内死亡率更高（41%对18%，P = 0.005）。多因素分析显示，术前肾功能不全（入院时估计肾小球滤过率＜40 mL/min/1.73m²，OR 2.106，P = 0.03）是LDLT后1年受者生存的独立危险因素，此外还有供体年龄≥38岁（OR 3.114，P＜0.001）、Child-Pugh-Turcotte评分≥13（OR 2.929，P＜0.001）和左叶移植（OR 2.225，P = 0.004）。
HRS的并存与LDLT后显著更差的预后相关，尤其是在移植后早期。
