Department of Transplantation Surgery, Karolinska University Hospital Huddinge, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
Department of Pediatric Gastroenterology, Hepatology and Nutrition, Astrid Lindgren Children's Hospital, Karolinska University Hospital Huddinge, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
Pediatr Transplant. 2021 Sep;25(6):e13993. doi: 10.1111/petr.13993. Epub 2021 May 19.
Impaired renal function after pediatric (LT) is a recognized problem. Accurate monitoring of (GFR) is imperative to detect declining renal function. GFR can be estimated via s-creatinine and/or p-cystatin C or measured by inulin and or/iohexol clearances. We retrospectively compared eGFRcrea and eGFRcyst, to mGFRiohex after LT. Data from 91 children with 312 concomitant measurements of s-creatinine, p-cystatin C, and iohexol clearance, obtained between 2007 and 2015, were analyzed. eGFR was calculated by using the p-cystatin C-based CAPA and CKD-EPI formulas, and the s-creatinine-based Schwartz-LYON, FAS, revised Schwartz and MDRD formulas. Also, the arithmetic means of cystatin C-based and creatinine-based equations were used. Every calculated eGFR was compared to mGFRiohex in statistical correlation, accuracy, precision, bias, and misclassifications. Among the different equations, p-cystatin C-based formulas (CAPA and CKD-EPI) as well as the s-creatinine-based Schwartz-LYON formula showed the most correct estimates regarding accuracy (84-87.5%), bias (0.19-4.0 ml/min/1.73 m ), and misclassification rate (24.7-25%). In patients with renal function <75 ml/min/1.73 m , cystatin C-based formulas were significantly more accurate and less biased than creatinine-based formulas. In conclusion, S-creatinine could be used in a clinical setting on a regular basis in liver transplanted pediatric patients, with reliable results, if eGFR is calculated by the Schwartz-LYON formula. When suspected renal dysfunction, cystatin C-based eGFR should be calculated, since it gives more accurate and less biased estimates than creatinine-based eGFR, and should be confirmed by mGFR (iohexol).
儿童期肝移植（LT）后肾功能受损是一个公认的问题。准确监测肾小球滤过率（GFR）对于发现肾功能下降至关重要。GFR 可以通过 s-肌酐和/或 p-胱抑素 C 估算，也可以通过菊粉和/或 iohexol 清除率测量。我们回顾性比较了 LT 后 s-肌酐和 p-胱抑素 C 估算的 eGFRcrea 和 eGFRcyst 与 mGFRiohex 的差异。分析了 2007 年至 2015 年间获得的 91 例儿童 312 次 s-肌酐、p-胱抑素 C 和 iohexol 清除率的同时测定数据。eGFR 通过基于 p-胱抑素 C 的 CAPA 和 CKD-EPI 公式以及基于 s-肌酐的 Schwartz-LYON、FAS、修订 Schwartz 和 MDRD 公式进行计算。此外，还使用了基于胱抑素 C 和肌酐的方程的算术平均值。在统计相关性、准确性、精密度、偏差和错误分类方面，将每个计算的 eGFR 与 mGFRiohex 进行比较。在不同的方程中，基于 p-胱抑素 C 的公式（CAPA 和 CKD-EPI）以及基于 s-肌酐的 Schwartz-LYON 公式在准确性（84-87.5%）、偏差（0.19-4.0 ml/min/1.73 m ）和错误分类率（24.7-25%）方面的估计最为正确。在肾功能 <75 ml/min/1.73 m 的患者中，基于胱抑素 C 的公式明显比基于肌酐的公式更准确且偏差更小。结论：在肝移植的儿科患者中，如果 eGFR 是通过 Schwartz-LYON 公式计算的，那么 s-肌酐可以在临床常规基础上使用，结果可靠。当怀疑存在肾功能障碍时，应计算基于胱抑素 C 的 eGFR，因为它比基于肌酐的 eGFR 能提供更准确和偏差更小的估计值，并且应该通过 mGFR（iohexol）来确认。
