Horvatits Thomas, Hübener Peter, Touma Marcel, Horvatits Karoline, Fischer Lutz, Lohse Ansgar W, Sterneck Martina
Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Ann Hepatol. 2021 Dec;26:100559. doi: 10.1016/j.aohep.2021.100559. Epub 2021 Oct 14.
Since MELD implementation renal impairment in liver transplant (LT) recipients has become of increasing importance. This is the first study evaluating the course of renal function immediately prior to LT as predictor for long-term renal and overall outcome.
In this retrospective study, 226 adults undergoing LT at the University Medical Center Hamburg-Eppendorf (2011-2015) were included. The impact of renal function over a period of 3 months prior to LT compared to renal function at the day of LT on long-term renal outcome and survival was assessed.
According to GFR at day of LT renal function improved (≥1 CKD stage) in 64 patients (28%), remained stable in 144 (64%) or deteriorated in 18 (8%). Improvement of renal function prior to LT did neither significantly affect 90-day (13% vs. 14%, p = 0.83), nor 5-year post-LT mortality (35% vs. 41%, p = 0.57). 50 patients (22%) with hepatorenal syndrome (HRS) received terlipressin prior to LT, but only 18 (37%) showed prolonged stabilization of renal function (improvement ≥1 CKD stage). Response to terlipressin did neither improve 90-day (p=1), 5-year mortality (p = 0.52) nor long-term renal function (p = 0.843). Nevertheless, need for dialysis pre-LT (59% vs. 34%, p = 0.005) and post-LT (62% vs. 17%, p<0.001) was associated with increased 5-year mortality.
Improvement of renal function immediately prior to LT, either spontaneously or following terlipressin therapy, did neither ameliorate long-term renal outcome nor survival in LT recipients. Future studies need to clarify the impact of terlipressin in HRS on the transplant waiting time in LT candidates.
自实施终末期肝病模型（MELD）以来，肝移植（LT）受者的肾功能损害变得愈发重要。这是第一项评估LT术前即刻肾功能作为长期肾脏及总体预后预测指标的研究。
在这项回顾性研究中，纳入了226例于汉堡-埃彭多夫大学医学中心接受LT的成年人（2011 - 2015年）。评估了LT术前3个月期间的肾功能与LT当日肾功能对长期肾脏预后和生存的影响。
根据LT当日的肾小球滤过率（GFR），64例患者（28%）肾功能改善（≥1个慢性肾脏病[CKD]分期），144例（64%）保持稳定，18例（8%）恶化。LT术前肾功能的改善对LT术后90天死亡率（13%对14%，p = 0.83）或5年死亡率（35%对41%，p = 0.57）均无显著影响。50例（22%）肝肾综合征（HRS）患者在LT术前接受了特利加压素治疗，但仅18例（37%）肾功能实现了长期稳定（改善≥1个CKD分期）。特利加压素治疗反应对90天死亡率（p = 1）、5年死亡率（p = 0.52）或长期肾功能（p = 0.843）均无改善作用。然而，LT术前（59%对34%，p = 0.005）及术后（62%对17%，p < 0.001）需要透析与5年死亡率增加相关。
LT术前即刻肾功能的改善，无论是自发的还是特利加压素治疗后，对LT受者的长期肾脏预后和生存均无改善作用。未来研究需要阐明特利加压素在HRS中对LT候选者移植等待时间的影响。
