肝肾综合征患者肝移植术后的临床结局：系统评价和荟萃分析。
Clinical Outcomes after Liver Transplantation for Hepatorenal Syndrome: A Systematic Review and Meta-Analysis.
机构信息
Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Department of Family Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
出版信息
Biomed Res Int. 2018 May 24;2018:5362810. doi: 10.1155/2018/5362810. eCollection 2018.
AIMS
Hepatorenal syndrome (HRS) decreases survival of cirrhotic patients. The outcomes of HRS after liver transplantation (LT) were inconsistently reported. We conducted a systematic review and meta-analysis study to estimate the post-LT rates of death and HRS reversal.
METHODS
A thorough search of literatures was performed on PubMed, Scopus, and conference abstracts for reports on post-LT survival and HRS reversal. Data for the posttransplant rates of HRS reversal, death, and acute rejection were extracted. The rates were pooled using inverse variance method if there was no heterogeneity between studies. Otherwise, the random effect model was applied.
RESULTS
Twenty studies were included. Pooling HRS reversal rates indicated high heterogeneity with a pooled rate of 0.834 (95% CI: 0.709-0.933). The pooled overall death rates for HRS and non-HRS after LT were 0.25 (95% confidence interval (CI): 0.18-0.33) and 0.19 (95% CI: 0.14-0.26). The risk ratio of death between HRS and non-HRS patients was 1.29 (95% CI: 1.14-1.47, < 0.001). The probability of death at 1, 3, and 5 years tended to be higher among HRS.
CONCLUSIONS
HRS is reversible in about 83% of patients after LT. However, the posttransplant mortality rate of HRS patients is still increased.
目的
肝肾综合征（HRS）降低了肝硬化患者的生存率。肝移植（LT）后 HRS 的结果报道不一致。我们进行了系统评价和荟萃分析研究，以估计 LT 后死亡和 HRS 逆转的发生率。
方法
在 PubMed、Scopus 和会议摘要中对文献进行了全面搜索，以检索关于 LT 后生存率和 HRS 逆转的报告。提取移植后 HRS 逆转、死亡和急性排斥反应的发生率数据。如果研究之间没有异质性，则使用Inverse Variance 方法汇总数据；否则，应用随机效应模型。
结果
共纳入 20 项研究。汇总 HRS 逆转率显示出高度异质性，合并率为 0.834（95%可信区间：0.709-0.933）。LT 后 HRS 和非 HRS 的总体死亡率分别为 0.25（95%置信区间：0.18-0.33）和 0.19（95%置信区间：0.14-0.26）。HRS 和非 HRS 患者的死亡风险比为 1.29（95%置信区间：1.14-1.47，<0.001）。HRS 患者在 1、3 和 5 年内死亡的概率更高。
结论
HRS 在大约 83%的 LT 后患者中是可逆转的。然而，HRS 患者的移植后死亡率仍然较高。
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