The Liver Unit, Queen Elizabeth University Hospital Birmingham, Birmingham, United Kingdom.
Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
Liver Transpl. 2019 Jun;25(6):922-933. doi: 10.1002/lt.25468.
The use of extended criteria donor (ECD) grafts has been associated with acute kidney injury (AKI) after liver transplantation. However, the relation between graft quality and development of chronic kidney disease (CKD) remains unknown. Therefore, the aim of this study was to analyze the impact of ECD grafts for CKD after liver transplantation. All patients (2007-2015) transplanted for end-stage liver disease at our center were assessed. Longterm kidney function was divided into 4 groups: no CKD (estimated glomerular filtration rate [eGFR], ≥60 mL/minute/1.73 m ), mild CKD (eGFR, 30-59 mL/minute/1.73 m ), severe CKD (eGFR, 15-29 mL/minute/1.73 m ), and end-stage renal disease (ESRD). Marginal donation after brain death (DBD) grafts (donor age, >70 years; body mass index, >35 kg/m ; cold storage, >12 hours) and donation after circulatory death (DCD) grafts were considered ECD grafts. Overall, 926 patients were included, and 43% received an ECD graft (15% marginal DBD; 28% DCD). After 5 years, 35% developed CKD; severe CKD and ESRD occurred in only 2% and 1%, respectively. CKD rates were comparable for all 3 graft groups (standard group, 36%; marginal DBD group, 29%; DCD group, 35%; standard versus marginal DBD groups, P = 0.16; standard versus DCD group, P = 0.80). None of the ECD criteria were identified as independent risk factors in a Cox regression model for CKD. Risk factors included recipient age, female sex, and preoperative kidney function. Furthermore, recipients who had severe acute kidney injury (AKI; Kidney Disease: Improving Global Outcomes stages 2 and 3) had a 1.8-fold increased risk for CKD. Longterm kidney function of recipients with severe AKI depended on the recovery of kidney function in the first postoperative week. In conclusion, there is no direct relation between the use of ECD grafts and CKD after liver transplantation. However, caution should be taken in recipients who experience severe AKI, regardless of graft type.
使用扩展标准供体（ECD）移植物与肝移植后急性肾损伤（AKI）有关。然而，移植物质量与慢性肾脏病（CKD）发展之间的关系尚不清楚。因此，本研究旨在分析 ECD 移植物对肝移植后 CKD 的影响。对我院 2007-2015 年所有因终末期肝病接受移植的患者进行评估。长期肾功能分为 4 组：无 CKD（估计肾小球滤过率[eGFR]≥60mL/min/1.73m ）、轻度 CKD（eGFR30-59mL/min/1.73m ）、重度 CKD（eGFR15-29mL/min/1.73m ）和终末期肾病（ESRD）。边缘脑死亡（DBD）供体（供体年龄>70 岁；体重指数>35kg/m ；冷保存>12 小时）和循环死亡（DCD）供体被认为是 ECD 移植物。共纳入 926 例患者，43%接受 ECD 移植物（15%边缘 DBD；28%DCD）。5 年后，35%的患者发生 CKD；重度 CKD 和 ESRD 分别仅占 2%和 1%。所有 3 个移植物组的 CKD 发生率相似（标准组 36%；边缘 DBD 组 29%；DCD 组 35%；标准与边缘 DBD 组比较，P=0.16；标准与 DCD 组比较，P=0.80）。在 Cox 回归模型中，ECD 标准均未被确定为 CKD 的独立危险因素。危险因素包括受体年龄、女性和术前肾功能。此外，严重急性肾损伤（AKI；改善全球肾脏病预后组织分期 2 和 3）的受体发生 CKD 的风险增加 1.8 倍。严重 AKI 受体的长期肾功能取决于术后第 1 周肾功能的恢复情况。总之，肝移植后使用 ECD 移植物与 CKD 之间没有直接关系。然而，对于发生严重 AKI 的受体，无论移植物类型如何，都应谨慎。
