术前合并慢性肾脏病受者的肝移植预后及其影响因素  

Early prognosis and risk factors of liver transplantation in patients with chronic kidney disease

作　　者：温培豪[1] 张嘉凯[1] 史晓奕[1] 王智慧[1] 胡博文[1] 曹胜利[1] 何玉婷[1] 郭文治[1] 张水军[1] Wen Peihao;Zhang Jiakai;Shi Xiaoyi;Wang Zhihui;Hu Bowen;Cao Shenli;He Yuting;Guo Wenzhi;Zhang Shuijun(Department of Hepatobiliary and Pancreatic Surgery,Key Laboratory of Hepatobiliary&Pancreatic Surgery&Digestive Organ Transplantation of Henan Province,First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院肝胆胰外科河南省高等学校肝胆胰外科与消化器官移植重点学科开放实验室,郑州450052

出　　处：《中华器官移植杂志》2020年第8期454-458,共5页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金联合基金项目(U1504804);河南省医学科技攻关计划联合共建项目(LHGJ20190287);河南省慈善总会肝胆相照基金(GDXZ2019005)。

摘　　要：目的分析合并慢性肾脏病(CKD)的终末期肝病受者接受肝移植术的早期预后及其危险因素。方法回顾性分析2018年1月至2020年5月在郑州大学第一附属医院完成的264例肝移植临床资料。参考慢性肾脏疾病流行病学协作方程(CKD-EPI),按照受者术前估算肾小球滤过率(eGFR)不同,将受者分为两组,CKD组纳入88例术前合并CKD(eGFR<90 ml/min/1.73 m2)的受者,对照组纳入同期176例肾功能正常(eGFR>90 ml/min/1.73 m2)的受者。采用χ2检验和t检验对比分析两组受者术后早期的死亡率、连续性肾脏替代治疗(CRRT)率和重症监护室(ICU)停留时间;分析受者相关因素对肝移植预后的影响;对比分析术后CKD2期与CKD3-5期受者肾功能恢复到CKD1期(eGFR>90 ml/min/1.73 m2)的情况。结果CKD组和对照组受者术后早期(3个月内)死亡率分别为9.1%(8/88)与1.1%(2/176),CRRT率分别为10.2%(9/88)与1.7%(3/176),ICU停留时间分别为(35.95±23.52)h与(22.30±7.78)h,两组间差异均有统计学意义(χ2=10.186,P=0.001;χ2=9.821,P=0.002;t=31.716,P=0.000)。单因素分析结果显示,CKD是肝移植术后受者死亡的危险因素,不同CKD分期受者的死亡率差异均有统计学意义(P=0.027),且术前CKD分期与受者术后死亡率呈线性关系(P=0.022)。CKD2期和CKD3-5期受者术后分别有35.5%(22/62)和11.5%(3/26)恢复到CKD1期,其中CKD4-5期无受者恢复到CKD1期,不同CKD分期受者术后eGFR恢复率的差异有统计学意义(χ2=4.798,P=0.036)。结论术前合并CKD受者的肝移植手术风险高于肾功能正常者。合并CKD是肝移植术后早期受者死亡的危险因素,且CKD分期与死亡率呈线性关系。术前CKD分期越高,术后肾功能恢复率越低。Objective To explore the early prognosis and risk factors of liver transplantation in patients with chronic kidney disease(CKD).Methods Clinical data of liver transplantation were retrospectively analyzed from January 2018 to May 2020.According to the formula of chronic kidney disease epidemiology collaboration(CKD-EPI),estimated glomerular filtration rate(eGFR)of recipients was calculated.Clinical data were recorded for 88 patients with chronic renal insufficiency(CKD group:eGFR<90 ml/min/1.73 m2)and 176 patients with normal renal function(normal renal function group:eGFR>90 ml/min/1.73 m2).Andχ2 and t tests were employed for analyzing early mortality,CRRT rate and ICU stay duration of two groups.They were divided into CKD stages 2,3,4 and 5 with eGFR 60-89,30-59,15-29 and<15 ml/min/1.73 m2 respectively.The prognostic effects of gender,age,body mass index(BMI),MELD,blood loss volume,blood transfusion volume,anhepatic time and CKD on the prognosis of liver transplantation were analyzed.The recovery of CKD 2 and CKD 3,4 and 5 to CKD 1(eGFR>90 ml/min/1.73 m2)was compared.Results Early mortality rate,CRRT rate and ICU stay duration were higher in CKD group than those in normal renal function group(χ2=10.186,P=0.001;χ2=9.821,P=0.002;t=31.716;P=0.000).Univariate analysis indicated that CKD was a risk factor for post-transplantation mortality.Significant difference existed in mortality among patients with different CKD stages(P=0.027)and there was a linear relationship between CKD stage and mortality(P=0.022).After transplantation,35.5(22/62)of CKD 2 and 11.5%(3/26)of CKD 3,4 and 5 recovered to CKD1 respectively.None of stages 4/5 CKD recovered to stage 1.The recovery rate of different CKD stages was statistically significant(χ2=4.798,P=0.036).Conclusions The risk of liver transplantation is higher in patients with chronic renal insufficiency than that in those with normal renal function.CKD is a risk factor for early post-transplantation mortality.And a linear relationship exists between CKD stage and mortality.Th

关 键 词：肝移植 合并症 慢性肾脏病 估算肾小球滤过率 预后 

分 类 号：R657.3[医药卫生—外科学] R692[医药卫生—临床医学]