R.C. Afonso, R. Hidalgo, M.P.V.C. Zurstrassen, L.E.P. Fonseca, F.L. Pandullo, M.B. Rezende, S.P. Meira-Filho, B.H. Ferraz-Neto

  肾功能衰竭是原位肝移植（OLT）手术的常见并发症（12%至70%），常常会导致不良后果，尤其是需要采用肾脏替代疗法（RRT）时后果更为严重。肝移植候选名单上的患者经常会出现肾功能不全。本研究的目的是分析OLT后患者出现肾功能衰竭的概率、与移植前肾功能不全之间的关系及其对移植疗效的影响。

  我们前瞻性的记录并分析了2003年3月至2007年11月期间由同一个移植小组进行的152例OLT，共涉及到139名患者。根据淘汰标准排除了34例，包括急性肝功能衰竭导致的肝移植、肝肾联合移植、再次移植、移植后2日内患者死亡等案例。我们根据OLT时测算的肌酐清除率（CCr）将118名患者分为两组：I组，OLT术前肾功能正常（CCr ≥ 70 mL/min）；II组，OLT术前肾功能衰竭（CCr < 70 mL/min）。根据OLT术后肾功能衰竭的病情发展情况，我们对每组患者进行了分析，同时将其分为A小组（OLT术后肾功能正常）、B小组（OLT术后轻度肾功能损伤—血清肌酐水平在2.0至3.0 mg/dL或为基线值的两倍3.0 mg/dL）、C小组（OLT术后严重肾功能损伤—血清肌酐水平≥ 3.0 mg/dL或采用RRT）。在22名（18.64%）采用RRT疗法的患者中，OLT术后肾功能损伤的总体发病率为41.52%。与其他患者相比，II组患者OLT术后肾功能衰竭的发病率更高（P < .05）；但是根据RRT需求，二者没有统计学差异。I组和II组患者的平均住院时间相似，各自的分组（A、B、C小组）也相似。两组患者的早期存活率（30天）和1年存活率也没有统计学差异。通过比较各个小分组的早期存活率和1年存活率，我们发现OLT术后出现严重肾功能衰竭的患者（I-C小组和II-C小组）疗效更差，其早期存活率和1年存活率分别为95.29% 和69.69%、86.95%和41.66%（P < .001）。

  总之，研究结果发现无论移植前肾功能如何，OLT术后出现严重肾功能衰竭的患者比其他患者的疗效更差。

Impact of Renal Failure on Liver Transplantation Survival
R.C. Afonso, R. Hidalgo, M.P.V.C. Zurstrassen, L.E.P. Fonseca, F.L. Pandullo, M.B. Rezende, S.P. Meira-Filho, B.H. Ferraz-Neto

Renal failure after orthotopic liver transplantation (OLT) is a common complication (ranging from 12% to 70%) associated with worse outcomes, particularly when it requires renal replacement therapy (RRT). Renal dysfunction is a common scenario among waiting list patients. It can lead to a worse prognosis after OLT, due to an increased incidence of postoperative renal failure. The aim of this study was to analyze the incidence of renal failure after OLT, its relationship to pretransplant renal dysfunction, and its impact on outcomes.

We analyzed data collected prospectively from 152 consecutive OLTs in 139 patients performed by the same team from March 2003 to November 2007. Exclusion criteria for 34 cases included transplantation due to acute liver failure, combined liver-kidney transplantation, retransplantation, and patients who died up to 2 days posttransplantation. Based on creatinine clearance (CCr) calculated at the time of OLT, the 118 patients were classified in two groups: group I, normal pre-OLT renal function (CCr ≥ 70 mL/min) versus group II, pre-OLT renal failure (CCr < 70 mL/min). Each group was analyzed according to the development of post-OLT renal failure, being classified as subgroup A (normal renal function post-OLT), subgroup B (mild renal impairment post-OLT—serum creatinine level between 2.0 and 3.0 mg/dL or doubled basal value up to 3.0 mg/dL) versus subgroup C (severe renal impairment post-OLT—serum creatinine level ≥ 3.0 mg/dL or utilization of RRT). The overall incidence of post-OLT renal impairment was 41.52% with RRT in 22 patients (18.64%). Group II patients showed a greater incidence of post-OLT renal failure when compared with other patients (P < .05), but without a statistical difference when compared according to RRT requirement. Comparison of average hospital stay was similar between groups I and II, and also among its subgroups (A, B, and C, respectively). There was no statistical difference in early (30-day) and 1-year survival rates between groups I and II. Comparing all subgroups for early and 1-year survival, we observed that patients who developed severe renal failure post-OLT (subgroups I-C and II-C) showed worse outcomes compared with other patients (subgroups I-A, I-B, II-A, and II-B), respectively 95.29% versus 69.69% and 86.95% versus 41.66% for early and 1-year survivals (P < .001).

In conclusion, our findings suggested that patients who developed severe renal failure post-OLT, independent of pretransplant renal function, showed worse outcomes.
Volume 40, Issue 3, Pages 808-810 (April 2008)

[责任编辑:刘 聪]