Early renal function post-liver transplantation is predictive of progressive chronic kidney disease
Early renal function post-liver transplantation is predictive of progressive chronic kidney disease
复制标题
DOI：
10.1080/00365520701679264
复制
发表时间：
2008-01-01
影响因子：
1.9
通讯作者：
Friman, Styrbjorn
中科院分区：
文献类型：
--
作者：
Herlenius, Gustaf;Fistouris, Johan;Friman, Styrbjorn
Objective.随着肝移植后长期结果的改善，慢性肾脏病（CKD）已成为一个高度相关的问题。早期测量肾小球滤过率（GFR）可以识别肝移植后数年内有发生CKD风险的患者。本研究的目的是描述肝移植后5年CKD的患病率，研究移植后早期测量的GFR与晚期肾功能之间的相关性，并确定肝移植后有发生晚期CKD风险的患者。材料和方法。共研究了152例肝移植术后至少5年的患者。用EDTA铬或碘海醇清除率测量的GFR随访5年（n=152）和10年（n=41）。结果5年后测量的GFR总体下降36%，10年后下降42%。8例患者（5%）需要肾脏替代治疗。移植前GFR水平与术后肾功能（5年）相关性较差。移植后3个月和1年测量的GFR与移植后5年测量的GFR相关性良好。多变量分析显示，移植后3个月测量的GFR小于30 ml与移植后5年的CKD显著相关。结论.肝移植后3个月时GFR水平低于30 ml/min/1.73 m2与肝移植后较长时间后CKD 4-5期的发展相关。这一发现的重要性是在早期阶段确定那些可能受益于早期实施钙调磷酸酶保留或停药方案的个体的可能性，其目标是保持长期肾功能。
Objective. With improvements in long-term results after liver transplantation, chronic kidney disease (CKD) has become a highly relevant problem. The early measurement of the glomerular filtration rate (GFR) can identify those patients who are at risk of developing CKD years after liver transplantation. The aims of this study were to describe the prevalence of CKD 5 years after liver transplantation, to study the correlation between measured GFR early after transplantation and late renal function and to identify patients at risk of developing late CKD after liver transplantation. Material and methods. A total of 152 patients who were at least 5 years post-liver transplantation were studied. Measured GFR with Chromium EDTA or iohexol clearance was followed-up for 5 years (n=152) and 10 years (n=41). Results. The overall decrease in measured GFR was 36% after 5 years and 42% after 10 years. Eight patients (5%) required renal replacement therapy. GFR levels pretransplantation showed a poor correlation with later renal function (at 5 years). The GFR measured at 3 months and 1 year post-transplantation correlated well with measured GFR at 5 years post-transplantation. Multivariate analysis showed that measured GFR of less than 30 ml at 3 months post-transplantation was significantly associated with CKD at 5 years post-transplantation. Conclusions. GFR levels below 30 ml/min/1.73 m2 at 3 months post-liver transplantation are associated with the development of later CKD Stage 4-5 long after liver transplantation. The importance of this finding is the possibility of identifying at an early stage those individuals that may benefit from early implementation of calcineurin sparing or a withdrawal regimen with the goal of preserving long-term renal function.