Lafayette R A, Paré G, Schmid C H, King A J, Rohrer R J, Nasraway S A
Department of Medicine, Surgery and Anesthesiology, New England Medical Center Hospital Tufts University School of Medicine, Boston, MA, USA.
Clin Nephrol. 1997 Sep;48(3):159-64.
The postoperative courses of 115 liver transplant recipients were reviewed to monitor for outcomes of acute renal failure and mortality. An analysis of baseline (preoperative) variables with particular attention to baseline renal function was accomplished to establish predictive variables for a complicated postoperative course. Acute renal failure requiring dialysis occurred in 27 cases (23%) and was associated with a prolonged ICU stay, greater infectious complications, greater hospital charges and a high mortality rate (46 +/- 11% vs. 9 +/- 3%) as compared to patients who did not experience acute renal failure. Death occurred in 20 patients (17%) overall prior to discharge. In order to assess the contribution of renal function, the population was divided arbitrarily into two groups based on preoperative serum creatinine. Group 1 (n = 50) had a preoperative serum creatinine < 1.0 mg/dl (mean +/- SD = 2.2 +/- 0.2 mg/dl) and Group 2 (n = 65) had a preoperative serum creatinine < or = 1.0 mg/dl (0.7 +/- 0.1 mg/dl). The groups experienced similar operative courses. Group 1 patients experienced significantly longer ICU stays (18 +/- 3 vs. 10 +/- 2 days), higher rates of acute renal failure requiring dialysis (52 +/- 7 vs. 5 +/- 2%), higher hospital charges (231,454 +/- 17,088 vs. 178,755 +/- 14,744 $, US) and a greatly increased mortality rate (32 +/- 1 vs. 6 +/- 1%), as compared to Group 2 patients. A multifactorial regression analysis demonstrated that of all pretransplant factors analyzed, elevation in the serum creatinine was significantly associated and was the strongest predictor of both outcomes: acute renal failure requiring dialysis (ROC = 0.89) and death (ROC = 0.83). The presence or absence of hepatorenal syndrome did not influence the results of this analysis. This study demonstrates that cirrhotic patients with renal dysfunction, as indicated by an elevated serum creatinine, experience a poor surgical outcome following liver transplantation. These patients may require special attention in the perioperative period. Alternatively, these data may influence the selection of ideal candidates for liver transplantation, where scarce resources need to be applied appropriately.
回顾了115例肝移植受者的术后病程，以监测急性肾衰竭和死亡率的结果。对基线（术前）变量进行了分析，特别关注基线肾功能，以确定术后复杂病程的预测变量。27例（23%）发生需要透析的急性肾衰竭，与未发生急性肾衰竭的患者相比，其ICU住院时间延长、感染并发症更多、住院费用更高且死亡率高（46±11%对9±3%）。总体上20例患者（17%）在出院前死亡。为了评估肾功能的影响，根据术前血清肌酐将人群任意分为两组。第1组（n = 50）术前血清肌酐<1.0 mg/dl（均值±标准差 = 2.2±0.2 mg/dl），第2组（n = 65）术前血清肌酐≥1.0 mg/dl（0.7±0.1 mg/dl）。两组手术过程相似。与第2组患者相比，第1组患者的ICU住院时间显著更长（18±3天对10±2天）、需要透析的急性肾衰竭发生率更高（52±7%对5±2%）、住院费用更高（231,454±17,088美元对178,755±14,744美元，美国）且死亡率大幅增加（32±1%对6±1%）。多因素回归分析表明，在所有分析的移植前因素中，血清肌酐升高与两种结果均显著相关，且是最强的预测因素：需要透析的急性肾衰竭（ROC = 0.89）和死亡（ROC = 0.83）。肝肾综合征的有无不影响该分析结果。本研究表明，血清肌酐升高表明肾功能不全的肝硬化患者肝移植术后手术结局较差。这些患者在围手术期可能需要特别关注。或者，这些数据可能会影响肝移植理想候选者的选择，因为需要合理分配稀缺资源。
