Long-term renal outcomes comparison between patients with chronic kidney disease and hepatorenal syndrome after living donor liver transplantation

被引：2

作者：

Tseng, Hsiang-Yu ^{[1
,2
,3
]}

Lin, Yu-Hung ^{[1
,2
,3
]}

Lin, Chih-Che ^{[1
,2
,3
]}

Chen, Chao-Long ^{[1
,2
,3
]}

Yong, Chee-Chien ^{[1
,2
,3
]}

Lin, Li-Man ^{[4
]}

Wang, Chih-Chi ^{[1
,2
,3
]}

Chan, Yi-Chia ^{[1
,2
,3
]}

机构：

[1] Kaohsiung Chang Gung Mem Hosp, Liver Transplantat Ctr, Kaohsiung, Taiwan

[2] Kaohsiung Chang Gung Mem Hosp, Dept Surg, Kaohsiung, Taiwan

[3] Chang Gung Univ, Coll Med, Kaohsiung, Taiwan

[4] Cheng Shiu Univ, Dept Early Childhood Care & Educ, Kaohsiung, Taiwan

来源：

FRONTIERS IN SURGERY | 2023年 / 10卷

关键词：

chronic kidney disease (CKD); end-stage liver disease (ESRD); hepatorenal syndrome (HRS); liver transplantation (LT); living donor LT (LDLT); DYSFUNCTION; RECIPIENTS; TACROLIMUS; EXPERIENCE; IMPACT;

D O I：

10.3389/fsurg.2023.1116728

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Background and aimsHepatorenal syndrome (HRS) is a disastrous renal complication of advanced liver disease with a poor prognosis. Restoring normal liver function through liver transplantation (LT) is a standardized treatment with favorable short-term survival. However, the long-term renal outcomes in patients with HRS receiving living donor LT (LDLT) are controversial. This study aimed to investigate the prognostic impact of LDLT in patients with HRS.MethodsWe reviewed adult patients who underwent LDLT between July 2008 and September 2017. Recipients were classified into 1) HRS type 1 (HRS1, N = 11), 2) HRS type 2 (HRS2, N = 19), 3) non-HRS recipients with pre-existing chronic kidney disease (CKD, N = 43), and 4) matched normal renal function (N = 67).ResultsPostoperative complications and 30-day surgical mortality were comparable among the HRS1, HRS2, CKD, and normal renal function groups. The 5-year survival rate was >90% and estimated glomerular filtration rate (eGFR) transiently improved and peaked at 4 weeks post-transplantation in patients with HRS. However, renal function deteriorated and resulted in CKD stage >= III in 72.7% of HRS1 and 78.9% of HRS2 patients (eGFR <60 ml/min/1.73 m(2)). The incidence of developing CKD and end-stage renal disease (ESRD) was similar between the HRS1, HRS2, and CKD groups, but significantly higher than that in the normal renal function group (both P < 0.001). In multivariate logistic regression, pre-LDLT eGFR <46.4 ml/min/1.73 m(2) predicted the development of post-LDLT CKD stage >= III in patients with HRS (AUC = 0.807, 95% CI = 0.617-0.997, P = 0.011).ConclusionsLDLT provides a significant survival benefit for patients with HRS. However, the risk of CKD stage >= III and ESRD among patients with HRS was similar to that in pre-transplant CKD recipients. An early preventative renal-sparing strategy in patients with HRS is recommended.

引用

页数：10

共 33 条

[21] Patterns of Kidney Function Before and After Orthotopic Liver Transplant: Associations With Length of Hospital Stay, Progression to End-Stage Renal Disease, and Mortality [J].