Yasui Toshihiro, Suzuki Tatsuya, Hara Fujio, Watanabe Shunsuke, Uga Naoko, Naoe Atsuki, Kondo Yasuhiro
From the Department of Pediatric Surgery, Fujita Health University, Toyoake, Aichi,Japan.
Exp Clin Transplant. 2018 Dec;16(6):708-713. doi: 10.6002/ect.2017.0159. Epub 2018 Mar 9.
In pediatric patients, renal dysfunction after living-donor liver transplant is a major issue that is difficult to evaluate. Recently, predictive equations for Japanese children have been introduced.
We conducted a retrospective study by prospectively collecting data on 26 patients under 16 years old who underwent living-donor liver transplant between June 2004 and March 2015. Serum creatinine and cystatin C levels were measured. Paired t tests and Bland-Altman plots were used to compare the following formulas for estimated glomerular filtration rate: the Schwartz formula and 3 formulas that were matched with Japanese children (polynomial, simple, and cystatin C formulas).
Average estimated glomerular filtrations rates (in mL/min/1.73 m2) were 143.46, 122.90, 121.58, and 123.31 using the Schwartz, polynomial, simple, and cystatin C formulas, respectively. The estimated glomerular filtrations rate for biliary atresia was 141.53 ± 31.37 versus 109.95 ± 19.52 for other diseases, with significant differences only noted with the cystatin C formula. The formulas tailored for Japanese children showed significantly lower estimated glomerular filtrations rates than those obtained using the Schwartz formula (P < .01).
The use of formulas for measuring estimated glomerular filtrations rates that are based on race may allow early detection of deteriorating renal function.
在儿科患者中,活体肝移植后的肾功能障碍是一个难以评估的主要问题。最近,已引入针对日本儿童的预测方程。
我们进行了一项回顾性研究,前瞻性收集了2004年6月至2015年3月期间接受活体肝移植的26例16岁以下患者的数据。测量血清肌酐和胱抑素C水平。采用配对t检验和Bland-Altman图比较以下估算肾小球滤过率的公式:施瓦茨公式以及与日本儿童匹配的3个公式(多项式、简单式和胱抑素C公式)。
使用施瓦茨公式、多项式公式、简单式公式和胱抑素C公式时,平均估算肾小球滤过率(单位:mL/min/1.73 m²)分别为143.46、122.90、121.58和123.31。胆道闭锁患者的估算肾小球滤过率为141.53±31.37,其他疾病患者为109.95±19.52,仅胱抑素C公式显示出显著差异。为日本儿童量身定制的公式显示出的估算肾小球滤过率显著低于使用施瓦茨公式得出的结果(P <.01)。
使用基于种族的估算肾小球滤过率公式可能有助于早期发现肾功能恶化情况。