Multi-Organ Transplant Program, Toronto General Hospital, Toronto, ON, Canada.
Department of Surgery, Medical University of Vienna, Vienna, Austria.
Liver Transpl. 2020 Jun;26(6):799-810. doi: 10.1002/lt.25755. Epub 2020 Apr 23.
Recipients of donation after circulatory death (DCD) grafts are reportedly at higher risk of developing renal dysfunction after liver transplantation (LT). We compared the development of acute kidney injury (AKI) and chronic kidney disease (CKD) after LT in recipients of DCD versus donation after brain death (DBD) or living donor liver transplantation (LDLT) livers. Adult recipients of DBD, LDLT, and DCD between 2012 and 2016 at Toronto General Hospital were included. AKI was defined as a post-LT increase of serum creatinine (sCr) ≥26.5 µmol/L within 48 hours or a ≥50% increase from baseline, and CKD was defined as an estimated glomerular filtration rate <60 mL/minute for >3 months. A total of 681 patients (DCD, n = 57; DBD, n = 446; and LDLT, n = 178) with similar baseline comorbidities were included. Perioperative AKI (within the first 7 postoperative days) was observed more frequently in the DCD group (61%; DBD, 40%; and LDLT, 44%; P = 0.01) and was associated with significantly higher peak AST levels (P < 0.001). Additionally, patients in the DCD group had a significantly higher peak sCr (P < 0.001) and a trend toward higher rates of AKI stage 3 (DCD, 33%; DBD, 21%; LDLT, 21%; P = 0.11). The proportions of recovery from AKI (DCD, 77%; DBD, 72%; LDLT, 78%; P = 0.45) and patients developing CKD (DCD, 33%; DBD, 32%; LDLT, 32%; P = 0.99) were similar. Nevertheless, patients who received DCD or DBD LT and required perioperative renal replacement therapy showed significantly lower patient survival in multivariate analysis (hazard ratio, 7.90; 95% confidence interval, 4.51-13.83; P < 0.001). In conclusion, recipients of DCD liver grafts experience higher rates of short-term post-LT renal dysfunction compared with DBD or LDLT. Additional risk factors for the development of severe kidney injury, such as high Model for End-Stage Liver Disease score, massive transfusions, or donor age ≥60 years should be avoided.
报道称，与脑死亡供体（DBD）或活体肝移植（LDLT）供体肝移植相比，接受循环死亡供体（DCD）移植物的患者在肝移植（LT）后发生肾功能障碍的风险更高。我们比较了 DCD 与 DBD 或 LDLT 供体的 LT 后急性肾损伤（AKI）和慢性肾脏病（CKD）的发展情况。纳入 2012 年至 2016 年多伦多总医院接受 DBD、LDLT 和 DCD 的成人受体。AKI 的定义为 LT 后 48 小时内血清肌酐（sCr）升高≥26.5µmol/L 或与基线相比升高≥50%，CKD 的定义为估计肾小球滤过率<60mL/min 持续>3 个月。共纳入 681 例（DCD，n=57；DBD，n=446；LDLT，n=178）患者，其基线合并症相似。DCD 组更常发生围手术期 AKI（术后 7 天内）（61%；DBD，40%；LDLT，44%；P=0.01），AST 水平峰值显著更高（P<0.001）。此外，DCD 组患者的 sCr 峰值显著更高（P<0.001），且 AKI 3 期的发生率呈升高趋势（DCD，33%；DBD，21%；LDLT，21%；P=0.11）。AKI 恢复（DCD，77%；DBD，72%；LDLT，78%；P=0.45）和发生 CKD（DCD，33%；DBD，32%；LDLT，32%；P=0.99）的患者比例相似。然而，在多变量分析中，接受 DCD 或 DBD LT 并需要围手术期肾脏替代治疗的患者的生存率显著较低（危险比，7.90；95%置信区间，4.51-13.83；P<0.001）。总之，与 DBD 或 LDLT 相比，DCD 肝移植受体术后更常发生短期 LT 后肾功能障碍。应避免发生严重肾损伤的其他危险因素，如终末期肝病模型评分高、大量输血或供体年龄≥60 岁。
