Pretransplant renal function predicts survival in patients undergoing orthotopic liver transplantation
Pretransplant renal function predicts survival in patients undergoing orthotopic liver transplantation
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DOI：
10.1053/jhep.2002.33160
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发表时间：
2002-05-01
期刊：
影响因子：
13.5
通讯作者：
Thuluvath, PJ
中科院分区：
文献类型：
--
作者：
Nair, S;Verma, S;Thuluvath, PJ
本研究的目的是利用联合器官共享网络（UNOS）数据库对1988年至1996年间接受原位肝移植（OLT）的成年人进行研究，以确定移植前肾功能对移植后移植和患者存活率的影响。根据OLT时计算的肌酐清除率（CCr），将患者随机分为肾功能正常（bb0 70 mL/min）、轻度（40-69.9 mL/min）、中度（20-39.9 mL/min）和重度（< 20 mL/min）肾功能不全。在接受移植的20,281例患者中，有19,261例患者的完整数据。其中，12778例（67%）CCr正常（平均118 +/- 50 mL/min）， 4419例（22%）轻度（56 +/- 8.5 mL/min）， 1560例（8%）中度（30 +/- 5.7 mL/min）， 504例（3%）重度（14 +/- 3.6 mL/min）肾功能衰竭。UNOS状态1在中重度肾功能衰竭患者中更为常见。中度或重度肾功能衰竭患者的原发性移植物无功能和30天死亡率较高，1、2、5年移植物和患者生存率较低。多元回归分析显示，在调整受体年龄、性别、肝病病因、糖尿病状态、体重指数、冷缺血时间和UNOS状态后，肾功能衰竭是30天和2年死亡率的独立预测因子。CCr低于40 mL/min与移植短期和长期生存率显著降低相关。总之，我们的研究结果表明，当Mayo终末期肝病（MELD）评分用于优先分配器官时，可能会出现低于预期的移植和患者存活率。
The objective of this study was to determine the impact of pretransplant renal function on graft and patient survival rates after orthotopic liver transplantation (OLT) using the United Network for Organ Sharing (UNOS) database for adults who underwent OLT between 1988 and 1996. Based on calculated creatinine clearance (CCr) at the time of OLT, patients were classified arbitrarily into those with normal renal function (> 70 mL/min) and mild (40-69.9 mL/min), moderate (20-39.9 mL/min), and severe (< 20 mL/min) renal insufficiency. Of the 20,281 patients who underwent transplantation, complete data were available for 19,261 patients. Of these, 12,778 (67%) had normal CCr (mean, 118 +/- 50 mL/min) and 4,419 (22%) had mild (56 +/- 8.5 mL/min), 1,560 (8%) had moderate (30 +/- 5.7 mL/min), and 504 (3%) had severe (14 +/- 3.6 mL/min) renal failure. UNOS status 1 was more common in patients with moderate and severe renal failure. Primary graft nonfunction and 30-day mortality rates were higher and 1-, 2-, and 5-year graft and patient survival rates were lower in patients with moderate or severe renal failure. Multiple regression analysis showed that renal failure was an independent predictor of 30-day and 2-year mortality after adjusting for the recipient's age, sex, etiology of liver disease, diabetes status, body mass index, cold ischemic time, and UNOS status. CCr less than 40 mL/min was associated with significantly lower short-term and long-term graft and patient survival rates. In conclusion, our findings suggest that when Mayo End-Stage Liver Disease (MELD) score is used to prioritize organ allocation, lower-than-expected graft and patient survival rates may be seen.