Factors influencing renal function after liver transplantation. Results from the MOST, an international observational study
Factors influencing renal function after liver transplantation. Results from the MOST, an international observational study
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DOI：
10.1016/j.dld.2008.09.018
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发表时间：
2009-05-01
影响因子：
4.5
通讯作者：
Villamil, F.
中科院分区：
文献类型：
--
作者：
Burra, P.;Senzolo, M.;Villamil, F.
导言。肾功能衰竭，包括急性和慢性，是肝移植后的常见并发症，可能严重危及长期结果。鉴于器官短缺，有必要确定哪些患者在肝移植(LT)后将经历进行性和严重的肾功能障碍。目的探讨肝移植术前肾功能、肝移植后肾功能衰竭的危险因素与移植后1、5年肾功能衰竭的关系，特别要注意丙型肝炎病毒的感染。这项分析使用了参加Neole(R)MOST(移植中的多国观察性研究)研究的肝脏部分的患者的数据。收集每个患者的丙型肝炎病毒状态、移植前血肌酐水平、受者性别、受者年龄、移植前动脉血压、移植前糖尿病、移植前抗病毒治疗、移植时间(2000年前后)和免疫抑制方案。移植后1年和5年肾功能衰竭的发生率被定义为GFR<；60mL/min/1.73m(2)(国家肾脏基金会III期)。这项研究考虑了1948名患者的数据。对406例肾小球滤过率(GFR)和233例肝移植术后5年的肾小球滤过率(GFR)进行了评估。丙型肝炎病毒感染率前者为35%，后者为37%。术后1年和5年的平均肾小球滤过率分别为70m L/m in/1.73m 2和69 m L/m in，丙型肝炎病毒阳性患者肝移植后1年和5年均显著低于丙型肝炎病毒阴性患者(p<；0.001)。移植前的肾小球滤过率与移植后1个月、1年和3年的肾小球滤过率呈正相关(P<；所有相关性均为0.0001)。多变量分析证实丙型肝炎病毒状态、移植前血肌酐水平和受者性别是1年肾功能恢复的显著预测因素(P<；三者均为0.001)。进一步分析受者性别的影响表明，在男性和女性患者中观察到的唯一显著的危险因素是丙型肝炎病毒阳性。只有1年的肾小球滤过率是5年肾小球滤过率的独立预测因子(p<；0.001)。丙型肝炎病毒阳性状态、环孢素(CsA)暴露、抗病毒治疗和糖尿病对5年GFR无显著影响。丙型肝炎病毒状态和肝移植前血肌酐水平是肝移植术后一年肾功能的独立预测因子。移植前与肾小球滤过率联合。从长期来看，丙型肝炎病毒阳性对肾功能的负面影响尚未得到证实，而移植后早期肾功能异常对预后的影响更为持久。(C)2008年《意大利胃肠病学杂志》。爱思唯尔有限公司出版。保留所有权利。
Introduction. Renal failure, both acute and chronic, is a common complication after liver transplantation and can seriously jeopardise long-term outcome. Given organ shortage it should be essential to determine which patients will experience progressive and severe renal dysfunction after liver transplantation (LT).Aim. To correlate pre-transplant renal function and risk factors for renal failure after liver transplantation with occurrence of renal failure at I and 5 years after LT, with particular attention to hepatitis C virus (HCV) infection.Methods. Data from patients enrolled in the liver section of Neoral(R) MOST (Multinational Observational Study in Transplantation) study were used for the analysis. HCV status, pre-transplant serum creatinine level, recipient gender, recipient age, pre-transplant arterial hypertension, pre-transplant diabetes mellitus, pre-transplant antiviral therapy, the time of the transplant (before or after 2000) and immunosuppressive regimen were collected for each patient. Post-transplant occurrence of renal failure at I and 5 years was defined as a GFR < 60 mL/min/1.73 m(2) (Stage III of the National Kidney Foundation).Results. Data from 1948 patients enrolled in the study were considered. Glomerular filtration rate (GFR) was evaluated in 406 patients at I year and in 233 patients at 5 years after LT. The prevalence of HCV infection was 35% in the former and 37% in the latter. The median GFR was 70 mL/min/1.73 m 2 after I year and 69 mL/min after 5 years, significantly lower in HCV-positive (HCV+) than in HCV-negative (HCV-) patients both I and 5 years after LT (p < 0.001). GFR before transplant correlated with GFR at I month, I and 3 years (P < 0.0001 for all correlations). Multivariate analysis confirmed HCV status, pre-LT serum creatinine levels and recipient gender as significant predictors of 1-year GFR (p < 0.001 for all three). Further analysis of the effect of recipient gender indicated that the only significant risk factor observed in both male and female patients was HCV positivity. Only I-year GFR was an independent predictor of 5-year GFR (p < 0.001). HCV+ status, cyclosporine (CsA) exposure, antiviral therapy and diabetes mellitus had no significant influence on 5-year GFR.Conclusions. HCV status and pre-LT serum creatinine levels were independent predictors of renal function a year after LT. together with GFR before transplant. The negative impact of HCV positivity on renal function was not confirmed in the long term, whereas the prognostic influence of an abnormal renal function in the early post-transplant period was more persistent. (C) 2008 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.