Bilbao I, Charco R, Balsells J, Lazaro J L, Hidalgo E, Llopart L, Murio E, Margarit C
Department of Surgery, Hospital General Vall D'Hebron, Barcelona, Spain.
Clin Transplant. 1998 Apr;12(2):123-9.
Acute renal failure (ARF) is a common and severe complication after liver transplantation (LT). The aim of this study was to ascertain the impact of ARF requiring dialysis in the outcome of LT and to analyze the risk factors leading to this event in the early post-operative period. From October 1988 to December 1994, 172 LT were performed in 158 patients. Postoperative ARF occurred in 88 transplants (51.1%) during the early postoperative period: mild ARF was found in 46 (serum creatinine 1.5-3 mg/dl), moderate ARF in 12 (serum creatinine > 3 mg/dl) and severe ARF in 30 (serum creatinine > 3 mg/dl with dialysis requirement). Preoperative, intraoperative, and postoperative variables were studied, comparing patients presenting severe ARF with the remaining patients. Postoperative mortality in the dialysed group was much higher than in the non-dialysis group (50% vs. 13.4%)(p < 0.001) and 1-yr actuarial graft survival was 73.4% for the non-dialysed group compared with 40.9% for the dialysed group (p < 0.05). Among 38 variables investigated, only two factors had independent prognostic value in multivariate analysis: preoperative serum creatinine > 1.5 mg/dl (OR = 4.4, p = 0.006) and graft dysfunction grades III-IV (OR = 8.9, p = 0.001). In conclusion, ARF is a severe complication post-LT; its appearance could be predicted in patients with pre-transplant renal dysfunction, severe graft dysfunction, or both. However, in many cases renal function may revert to normal if treated aggressively with early dialysis support.
急性肾衰竭（ARF）是肝移植（LT）后常见且严重的并发症。本研究旨在确定需要透析的ARF对LT结局的影响，并分析术后早期导致该事件的危险因素。1988年10月至1994年12月，对158例患者进行了172例LT手术。术后早期88例移植患者（51.1%）发生了ARF：46例为轻度ARF（血清肌酐1.5 - 3mg/dl），12例为中度ARF（血清肌酐>3mg/dl），30例为重度ARF（血清肌酐>3mg/dl且需要透析）。研究了术前、术中和术后变量，将出现严重ARF的患者与其余患者进行比较。透析组的术后死亡率远高于非透析组（50%对13.4%）（p<0.001），非透析组1年的移植存活率为73.4%，而透析组为40.9%（p<0.05）。在研究的38个变量中，多因素分析仅有两个因素具有独立的预后价值：术前血清肌酐>1.5mg/dl（OR = 4.4，p = 0.006）和移植功能障碍III - IV级（OR = 8.9，p = 0.001）。总之，ARF是LT后的严重并发症；移植前肾功能不全、严重移植功能障碍或两者兼有的患者可能会出现ARF。然而，在许多情况下，如果早期给予积极的透析支持治疗，肾功能可能会恢复正常。
