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中华移植杂志(电子版) ›› 2020, Vol. 14 ›› Issue (01) : 44 -48. doi: 10.3877/cma.j.issn.1674-3903.2020.01.012

所属专题: 文献

综述

肝移植术后并发急性肾损伤的诊疗进展
邓攀1, 赵于军1, 王强1, 张盛1, 明英姿1,()   
  1. 1. 410000 长沙,中南大学湘雅三医院器官移植中心
  • 收稿日期:2019-06-06 出版日期:2020-02-25
  • 通信作者: 明英姿
  • 基金资助:
    国家自然科学基金(81771722, 81700658)

Progress of diagnosis and treatment of acute kidney injury after liver transplantation

Pan Deng1, Yujun Zhao1, Qiang Wang1, Sheng Zhang1, Yingzi Ming1,()   

  1. 1. Organ Transplantation Center, Third Xiangya Hospital, Central South University, Changsha 410000, China
  • Received:2019-06-06 Published:2020-02-25
  • Corresponding author: Yingzi Ming
  • About author:
    Corresponding author: Ming Yingzi, Email:
引用本文:

邓攀, 赵于军, 王强, 张盛, 明英姿. 肝移植术后并发急性肾损伤的诊疗进展[J/OL]. 中华移植杂志(电子版), 2020, 14(01): 44-48.

Pan Deng, Yujun Zhao, Qiang Wang, Sheng Zhang, Yingzi Ming. Progress of diagnosis and treatment of acute kidney injury after liver transplantation[J/OL]. Chinese Journal of Transplantation(Electronic Edition), 2020, 14(01): 44-48.

肝移植是目前治疗终末期肝病的主要手段,但移植术后常并发急性肾损伤(AKI),直接或间接影响受者移植术后生存质量及长期生存率。肝移植术后并发AKI的发病机制和病理改变复杂多样。移植术前、术中和术后等多种因素(包括供、受者因素、手术和移植后早期免疫抑制剂的使用等)均可能导致AKI。本文对近年来肝移植术后并发AKI的相关研究进行综述,总结其发病机制及临床诊治经验,以期为临床预防及早期诊治提供依据,改善受者预后。

Liver transplantation is currently the main method for treating end-stage liver disease, but acute kidney injury (AKI) often occurs after transplantation, which directly or indirectly affects the recipient′s quality of life and long-term survival after transplantation. The pathogenesis and pathologic changes of AKI after liver transplantation are complex and diverse. A variety of factors (including donor and recipient factors, the use of surgery and early immunosuppressive agents after transplantation and so on) may cause AKI before, during, and after transplantation. This article tries to review the research progress on liver transplantation recipients accompanied with AKI after transplantation. The pathogenesis, and clinical diagnosis and treatment experience for AKI after liver transplantation are summarized, with a view to providing a basis for clinical prevention and early diagnosis and treatment, and improving the prognosis of the recipients.

1
Jain A. Long-term survival after liver transplantation in 4 000 consecutive patients at a single center[J]. Ann Surg, 2000, 232(4): 490-500.
2
中国医师协会器官移植医师分会,中华医学会器官移植学分会肝移植学组. 中国肝移植受者肾损伤管理专家共识(2017版)[J/CD]. 中华移植杂志:电子版,2017, 11(3): 130-137.
3
Angeli P, Bezinover D, Biancofiore G, et al. Acute kidney injury in liver transplant candidates: a position paper on behalf of the Liver Intensive Care Group of Europe[J]. Minerva Anestesiol, 2017, 83(1): 88-101.
4
Rubin A, Sanchez-Montes C, Aguilera V, et al. Long-term outcome of ′long-term liver transplant survivors′[J]. Transpl Int, 2013, 26(7):740-750.
5
Levitsky J, O′Leary JG, Asrani S, et al. Protecting the kidney in liver transplant recipients:practice-based recommendations from the American society of Transplantation Liver and Intestine Community of Practice[J]. Am J Transplant, 2016, 16(9): 2532-2544.
6
Francoz C, Nadim MK, Baron A, et al. Glomerular filtration rate equations for liver-kidney transplantation in patients with cirrhosis: validation of current recommendations[J]. Hepatology, 2014, 59(4): 1514-1521
7
Ostermann M, Joannidis M. Acute kidney injury 2016: diagnosis and diagnostic workup[J]. Crit Care, 2016, 20(1): 299.
8
Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury[J]. Kidney Int Suppl, 2012, 2(Suppl 1): S1-S138.
9
Cullaro G, Park M, Lai J. ″Normal″ creatinine levels predict persistent kidney injury and waitlist mortality in outpatients with cirrhosis[J]. Hepatology, 2018, 68(5): 1953-1960.
10
Vagefi PA, Qian JJ, Carlson DM, et al. Native renal function after combined liver-kidney transplant for type 1 hepatorenal syndrome: initial report on the use of postoperative Technetium-99m-mercaptoacetyltriglycine scans[J]. Transplant Int, 2013, 26(5): 471-476.
11
Leithead JA, Ferguson JW. Chronic kidney disease after liver transplantation[J]. J Hepatol, 2015, 62(1): 243-244.
12
Inker LA, Schmid CH, Tighiouart H, et al. Estimating glomerular filtration rate from serum creatinine and cystatin C[J]. N Engl J Med, 2012, 367(1): 20-29.
13
Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtrationrate[J]. Ann Intern Med, 2009, 150(9): 604-612.
14
Gowrishankar M, VanderPluym C, Robert C, et al. Value of serum cystatin C in estimating renal function in children with non-renal solid organ transplantation[J]. Pediatr Transplant, 2015, 19(1): 27-34.
15
Singal AK, Jackson B, Pereira GB, et al. Biomarkers of Renal Injury in cirrhosis: association with acute kidney injury and recovery after liver transplantation[J]. Nephron, 2018, 138(1): 1-12.
16
Wadei HM, Geiger XJ, Cortese C, et al. Kidney allocation to liver transplant candidates with renal failure of undetermined etiology: role of percutaneous renal biopsy[J]. Am J Transplant, 2008, 8(12): 2618-2626.
17
Fagundes C, Pepin MN, Guevara M, et al. Urinary neutrophil gelatinase-associated lipocalin as biomarker in the differential diagnosis of impairment of kidney function in cirrhosis[J]. J Hepatol, 2012, 57(2): 267-273.
18
Barreto R, Elia C, Sola E, et al. Urinary neutrophil gelatinase-associated lipocalin predicts kidney outcome and death in patients with cirrhosis and bacterial infections[J]. J Hepatol, 2014, 61(1): 35-42.
19
Belcher JM, Garcia-Tsao G, Sanyal AJ, et al. Urinary biomarkers and progression of AKI in patients with cirrhosis[J]. Clin J Am Soc Nephrol, 2014, 9(11): 1857-1867.
20
Verna EC, Brown RS, Farrand E, et al. Urinaryneutrophil gelatinase-associated lipocalin predicts mortality and identifies acute kidney injury in cirrhosis[J]. Dig Dis Sci, 2012, 57(9): 2362-2370.
21
Belcher JM, Sanyal AJ, Peixoto AJ, et al. Kidney biomarkers and differential diagnosis of patients with cirrhosis and acute kidney injury[J]. Hepatology, 2014, 60(2): 622-632.
22
Ariza X, Sola E, Elia C, et al. Analysis of a urinary biomarker panel for clinical outcomes assessment in cirrhosis[J]. PLoS One, 2015, 10(6): e0128145.
23
Wagener G, Minhaz M, Mattis FA, et al. Urinary neutrophil gelatinase-associated lipocalin as a marker of acute kidney injury after orthotopic liver transplantation[J]. Nephrol Dial Transplant, 2011, 26(5): 1717-1723.
24
Levitsky J, Baker TB, Jie C, et al. Plasma protein biomarkers enhance the clinical prediction of kidney injury recovery in patients undergoing liver transplantation[J]. Hepatology, 2014, 60(6): 2017-2026.
25
Francoz C, Nadim MK, Durand F. Kidney biomarkers in cirrhosis[J]. J Hepatol, 2016, 65(4): 809-824.
26
O′Riordan A, Wong V, McQuillan R, et al. Acute renal disease, as defined by the RIFLE criteria, post-liver transplantation[J]. Am J Transplant, 2007, 7(1): 168-176.
27
Nadim MK, Genyk YS, Tokin C, et al. Impact of the etiology of acute kidney injury on outcomes following liver transplantation: acute tubular necrosis versus hepatorenal syndrome[J]. Liver Transpl, 2012, 18(5): 539-548.
28
Piano S, Rosi S, Maresio G, et al. Evaluation of the acute kidney injury network criteria in hospitalized patients with cirrhosis and ascites[J]. J Hepatol, 2013, 59(3): 482-489.
29
Durand F, Graupera I, Gines P, et al. Pathogenesis of hepatorenal syndrome: implications for therapy[J]. Am J Kidney Dis, 2016, 67(2): 318-328.
30
Trawale JM, Paradis V, Rautou PE, et al. The spectrum of renal lesions in patients with cirrhosis: a clinicopathological study[J]. Liver Int, 2010, 30(5): 725-732.
31
Hilmi IA, Damian D, Al-Khafaji A, et al. Acute kidney injury following orthotopic liver transplantation: incidence, risk factors, and effects on patient and graft outcomes[J]. Br J Anaesth, 2015, 114(6): 919-926.
32
Leithead JA, Tariciotti L, Gunson B, et al. Donation after cardiac death liver transplant recipients have an increased frequency of acute kidney injury[J]. Am J Transplant, 2012, 12(4): 965-975.
33
Goren O, Matot I. Update on perioperative acute kidney injury[J]. Curr Opin Crit Care, 2016, 22(4): 370-378.
34
Aggarwal S, Kang Y, Freeman JA, et al. Postreperfusion syndrome: hypotension after reperfusion of the transplanted liver[J]. J Crit Care, 1993, 8(3): 154-160.
35
De Haan JE, Hoorn EJ, de Geus HRH. Acute kidney injury after liver transplantation:Recent insights and future perspectives[J]. Best Pract Res Clin Gastroenterol, 2017, 31(2): 161-169.
36
Karkouti K. Transfusion and risk of acute kidney injury in cardiac surgery[J]. Br J Anaesth, 2012, 109(Suppl 1): i29-i38.
37
Chow FS, Piekoszewski W, Jusko WJ. Effect of hematocrit and albumin concentration on hepatic clearance of tacrolimus (FK506) during rabbit liver perfusion[J]. Drug Metab Dispos, 1997, 25(5): 610-616.
38
Yoo S, Lee HJ, Lee H, et al. Association between perioperative hyperglycemia or glucose variability and postoperative acute kidney injury after liver transplantation: a retrospective observational study[J]. Anesth Analg, 2017, 124(1): 35-41.
39
Wadei HM, Lee DD, Croome KP, et al. Early allograft dysfunction after liver transplantation is associated with short-and long-term kidney function impairment[J]. Am J Transplant, 2016, 16(3): 850-859.
40
Laing RW, Scalera I, Isaac J, et al. Liver transplantation using grafts from donors after circulatory death: A propensity-matched study from a single centre[J]. Am J Transplant, 2016, 16(6): 1795-1804.
41
Elia C, Graupera I, Barreto R, et al. Severe acute kidney injury associated with nonsteroidal anti-inflammatory drugs in cirrhosis: a case-control study[J]. J Hepatol, 2015, 63(3): 593-600.
42
Angeli P, Gines P, Wong F, et al. Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites[J]. J Hepatol, 2015, 62(4): 968-974.
43
Rodriguez E, Henrique Pereira G, Sola E, et al. Treatment of type 2 hepatorenal syndrome in patients awaiting transplantation: effects on kidney function and transplantation outcomes[J]. Liver Int, 2015, 21(11): 1347-1354.
44
Fernandez J, Navasa M, Planas R, et al. Primary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis[J]. Gastroenterology, 2007, 133(3): 818-824.
45
European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis[J]. J Hepatol, 2010, 53(3): 397-417.
46
Serste T, Francoz C, Durand F, et al. Beta-blockers cause paracentesis-induced circulatory dysfunction in patients with cirrhosis and refractory ascites: a cross-over study[J]. J Hepatol, 2011, 55(4): 794-799.
47
Leithead JA, Rajoriya N, Tehami N, et al. Non-selective beta-blockers are associated with improved survival in patients with ascites listed for liver transplantation[J]. Gut, 2015, 64(7): 1111-1119.
48
Nadim MK, Durand F, Kellum JA, et al. Management of the critically ill patient with cirrhosis: a multidisciplinary perspective[J]. J Hepatol, 2016, 64(3): 717-735.
49
Wierstra BT, Kadri S, Alomar S, et al. The impact of" early" versus " late" initiation of renal replacement therapy in critical care patients with acute kidney injury: a systematic review and evidence synthesis[J]. Crit Care, 2016, 20(1): 122.
50
Zarbock A, Kellum JA, Schmidt C, et al. Effect of early vs delayed initiation of renal replacement therapy on mortality in critically ill patients with acute kidney injury: the ELAIN randomized clinical trial[J]. JAMA, 2016, 315(20): 2190-2199.
51
Paugam-Burtz C, Kavafyan J, Merckx P, et al. Postreperfusion syndrome during liver transplantation for cirrhosis: outcome and predictors[J]. Liver Transpl, 2009, 15(5): 522-529.
52
Schmitz V, Schoening W, Jelkmann I, et al. Different cava reconstruction techniques in liver transplantation: piggyback versus cava resection[J]. Hepatobiliary Pancreat Dis Int, 2014, 13(3): 242-249.
53
Pratschke S, Meimarakis G, Bruns CJ, et al. Temporary intraoperative porto-caval shunt:useless or beneficial in piggy back liver transplantation?[J]. Transplant Int, 2013, 26(1): 90-98.
54
Salom MG, Ramirez P, Carbonell LF, et al. Protective effect of N-acetyl-L-cysteine on the renal failure induced by inferior vena cava occlusion[J]. Transplantation, 1998, 65(10): 1315-1321.
55
Durand F. Hot-topic debate on kidney function: renal-sparing approaches are beneficial[J]. Liver Transpl, 2011, 17(Suppl 3): S43-S49.
56
Kong Y, Wang D, Shang Y, et al. Calcineurin-inhibitor minimization in liver transplant patients with calcineurin-inhibitor-related renal dysfunction: a meta-analysis[J]. PLoS One, 2011, 6(9): e24387.
57
Goralczyk AD, Bari N, Abu-Ajaj W, et al. Calcineurin inhibitor sparing with mycophenolate mofetil in liver transplantion: a systematic review of randomized controlled trials[J]. Am J Transplant, 2012, 12(10): 2601-2607.
58
Teperman L, Moonka D, Sebastian A, et al. Calcineurin inhibitor-free mycophenolate mofetil/sirolimus maintenance in liver transplantation: the randomized spare-the-nephron trial[J]. Liver Transpl, 2013, 19(7): 675-689.
59
Fischer L, Klempnauer J, Beckebaum S, et al. A randomized, controlled study to assess the conversion from calcineurin-inhibitors to everolimus after liver transplantation-PROTECT[J]. Am J Transplant, 2012, 12(7): 1855-1865.
60
Klintmalm GB, Feng S, Lake JR, et al. Belatacept-based immunosuppression in de novo liver transplant recipients: 1-year experience from a phase Ⅱ randomized study[J]. Am J Transplant, 2014, 14(8): 1817-1827.
61
Yoshida EM, Marotta PJ, Greig PD, et al. Evaluation of renal function in liver transplant recipients receiving daclizumab (Zenapax), mycophenolate mofetil, and a delayed, low-dose tacrolimus regimen vs. a standard-dose tacrolimus and mycophenolate mofetil regimen: a multicenter randomized clinical trial[J]. Liver Transpl, 2005, 11(9): 1064-1072.
62
Abdelmalek MF, Humar A, Stickel F, et al. Sirolimus conversion regimen versus continued calcineurin inhibitors in liver allograft recipients: a randomized trial[J]. Am J Transplant, 2012, 12(3): 694-705.
63
Lin M, Mittal S, Sahebjam F, et al. Everolimus with early withdrawal or reduced-dose calcineurin inhibitors improves renal function in liver transplant recipients: a systematic review and meta-analysis[J]. Clin Transplant, 2017, 31(2): e12872.
64
Davis CL, Feng S, Sung R, et al. Simultaneous liver-kidney transplantation: evaluation to decision making[J]. Am J Transplant, 2007, 7(7): 1702-1709.
65
Simpson N, Cho YW, Cicciarelli JC, et al. Comparison of renal allograft outcomes in combined liver-kidney transplantation versus subsequent kidney transplantation in liver transplant recipients: analysis of UNOS database[J]. Transplantation, 2006, 82(10): 1298-1303.
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