Singh Neeraj, Ahmadzadeh Shahab, Shokouh-Amiri Hosein, Qazi Yasir A, Sequeira Adrian, Samant Hrishikesh, McMillan Robert, Zibari Gazi B
John C. McDonald Regional Transplant Center, Willis Knighton Medical Center, Shreveport, LA, USA.
Division of Nephrology, Department of Medicine, LSUHSC-S, Shreveport, LA, USA.
Clin Transplant. 2017 Sep;31(9). doi: 10.1111/ctr.13008. Epub 2017 Jul 26.
Kidney transplant in patients with liver cirrhosis and nondialysis chronic kidney disease (CKD) is controversial. We report 14 liver cirrhotic patients who had persistently low MDRD-6 estimated glomerular filtration rate (e-GFR) <40 mL/min/1.73 m for ≥3 months and underwent either liver transplant alone (LTA; n=9) or simultaneous liver-kidney transplant (SLKT; n=5). Pretransplant, patients with LTA compared with SLKT had lower serum creatinine (2.5±0.73 vs 4.6±0.52 mg/dL, P=.001), higher MDRD-6 e-GFR (21.0±7.2 vs 10.3±2.0 mL/min/1.73 m , P=.002), higher 24-hour urine creatinine clearance (34.2±8.8 vs 18.0±2.2 mL/min, P=.002), lower proteinuria (133.2±117.7 vs 663±268.2 mg/24 h, P=.0002), and relatively normal kidney biopsy and ultrasound findings. Post-LTA, the e-GFR (mL/min/1.73 m ) increased in all nine patients, with mean e-GFR at 1 month (49.8±8.4), 3 months (49.6±8.7), 6 months (49.8±8.1), 12 months (47.6±9.2), 24 months (47.9±9.1), and 36 months (45.1±7.3) significantly higher compared to pre-LTA e-GFR (P≤.005 at all time points). One patient developed end-stage renal disease 9 years post-LTA and another patient expired 7 years post-LTA. The low e-GFR alone in the absence of other markers or risk factors of CKD should not be an absolute criterion for SLKT in patients with liver cirrhosis.
肝硬化合并非透析慢性肾脏病（CKD）患者的肾移植存在争议。我们报告了14例肝硬化患者，其MDRD-6估计肾小球滤过率（e-GFR）持续低于40 mL/min/1.73 m²达3个月以上，并接受了单纯肝移植（LTA；n = 9）或同期肝肾联合移植（SLKT；n = 5）。移植前，LTA患者与SLKT患者相比，血清肌酐水平较低（2.5±0.73 vs 4.6±约0.52 mg/dL，P = 0.001），MDRD-6 e-GFR较高（21.0±7.2 vs 10.3±2.0 mL/min/1.73 m²，P = 0.002），24小时尿肌酐清除率较高（34.2±8.8 vs 18.0±2.2 mL/min，P = 0.002），蛋白尿较低（133.2±117.7 vs 663±268.2 mg/24 h，P = 0.0002），且肾活检和超声检查结果相对正常。LTA术后，所有9例患者的e-GFR（mL/min/1.73 m²）均升高，术后1个月（49.8±8.4）、3个月（49.6±8.7）、6个月（49.8±8.1）、12个月（47.6±9.2）、24个月（47.9±9.1）和36个月（45.1±7.3）的平均e-GFR均显著高于LTA术前的e-GFR（所有时间点P≤0.005）。1例患者在LTA术后9年发展为终末期肾病，另1例患者在LTA术后7年死亡。对于肝硬化患者，仅低e-GFR而无其他CKD标志物或危险因素，不应作为SLKT的绝对标准。
