Department of Transplantation, Mayo Clinic Florida, Jacksonville, FL.
Department of Health Sciences Research, Mayo Clinic Florida, Jacksonville, FL.
Liver Transpl. 2021 Sep;27(9):1291-1301. doi: 10.1002/lt.26047. Epub 2021 Jul 21.
Pre-liver transplantation (LT) renal dysfunction is associated with poor post-LT survival. We studied whether early allograft dysfunction (EAD) modifies this association. Data on 2,856 primary LT recipients who received a transplant between 1998 and 2018 were retrospectively reviewed. Patients who died within the first post-LT week or received multiorgan transplants and previous LT recipients were excluded. EAD was defined as (1) total bilirubin ≥ 10 mg/dL on postoperative day (POD) 7, (2) international normalized ratio ≥1.6 on POD 7, and/or (3) alanine aminotransferase or aspartate aminotransferase ≥2000 IU/mL in the first postoperative week. Pre-LT renal dysfunction was defined as serum creatinine >1.5 mg/dL or on renal replacement therapy at LT. Patients were divided into 4 groups according to pre-LT renal dysfunction and post-LT EAD development. Recipients who had both pre-LT renal dysfunction and post-LT EAD had the worst unadjusted 1-year, 3-year, and 5-year post-LT patient and graft survival, whereas patients who had neither renal dysfunction nor EAD had the best survival (P < 0.001). After adjusting for multiple factors, the risk of death was significantly higher only in those with both pre-LT renal dysfunction and post-LT EAD (adjusted hazard ratio [aHR], 2.19; 95% confidence interval [CI], 1.58-3.03; P < 0.001), whereas those with renal dysfunction and no EAD had a comparable risk of death to those with normal kidney function at LT (aHR, 1.12; 95% CI, 0.86-1.45; P = 0.41). Results remained unchanged when pre-LT renal dysfunction was redefined using different glomerular filtration rate cutoffs. Pre-LT renal dysfunction negatively impacts post-LT survival only in patients who develop EAD. Livers at higher risk of post-LT EAD should be used with caution in recipients with pre-LT renal dysfunction.
肝移植前（LT）肾功能障碍与 LT 后生存率降低有关。我们研究了早期移植物功能障碍（EAD）是否改变了这种关联。回顾性分析了 1998 年至 2018 年间接受移植的 2856 例原发性 LT 受者的数据。排除了 LT 后第一周内死亡或接受多器官移植和以前 LT 受者的患者。EAD 的定义为：（1）术后第 7 天总胆红素≥10mg/dL；（2）术后第 7 天国际标准化比值≥1.6；（3）术后第一周丙氨酸转氨酶或天冬氨酸转氨酶≥2000IU/mL。LT 前肾功能障碍定义为血清肌酐>1.5mg/dL 或 LT 时接受肾脏替代治疗。根据 LT 前肾功能障碍和 LT 后 EAD 的发生情况，将患者分为 4 组。同时存在 LT 前肾功能障碍和 LT 后 EAD 的患者，未经调整的 1 年、3 年和 5 年 LT 后患者和移植物存活率最差，而既无肾功能障碍又无 EAD 的患者存活率最高（P<0.001）。调整多个因素后，只有同时存在 LT 前肾功能障碍和 LT 后 EAD 的患者死亡风险显著增加（调整后的危险比[aHR]，2.19；95%置信区间[CI]，1.58-3.03；P<0.001），而 LT 时肾功能障碍而无 EAD 的患者的死亡风险与肾功能正常的患者相当（aHR，1.12；95%CI，0.86-1.45；P=0.41）。当使用不同的肾小球滤过率截止值重新定义 LT 前肾功能障碍时，结果保持不变。LT 前肾功能障碍仅在发生 EAD 的患者中对 LT 后生存率产生负面影响。在 LT 前有肾功能障碍的患者中，应谨慎使用具有较高 LT 后 EAD 风险的肝脏。
