肝移植后肾功能不全37例

Renal inadequacy following liver transplantation in 37 cases

背景:肝移植后,由于手术创伤和免疫抑制剂的应用极易造成急性肾功能不全,其诊断和治疗,目前尚无统一诊断标准。目的:分析肝移植后肾功能不全的相关因素和诊治经验。设计、时间及地点:2004-01/2006-12在解放军第四五八医院完成。对象:肝移植37例,男35例,女2例,年龄37～67岁,平均(48.5±8.9)岁。根据原发病分为肝硬化组21例,包括乙型肝炎后肝硬化16例,丙型肝炎后肝硬化4例,酒精性肝硬化1例,均为肝硬化失代偿期;肝癌组16例。移植后均经病理检查确诊。方法:按背驮式改进方法实施供肝和病肝病切除及肝脏血液流出道重建。移植后每天查血和引流物细菌培养1次,每天查动脉血气分析、血常规、肾功能及肝功能检查2次以上。肝移植患者术后常规应用三代头孢雷素、大扶康及更昔洛韦或并用万古霉素等药5～7d预防细菌、霉菌及病毒感染。主要观察指标:急性肾功能不全发生率、患者的临床特征、尿量变化、治疗转归情况等。结果:肝移植后发生急性肾功能不全19例,死亡5例,14例患者于术后两三周内肾功能恢复正常。肝移植相关肾功能不全的发生与感染、失血性休克,呼吸衰竭和急性呼吸窘迫综合征有关(P<0.05)。结论:肝移植相关肾功能不全的发生率高为51.35%。死亡率为26.32%,早期诊断和治疗肝移植相关肾功能不全是提高肝移植后急性肾功能不全患者治疗成功率的关键。

BACKGROUND：Acute renal insufficiency （ARI） usually occurred following liver transplantation due to the surgical trauma and the application of immunosuppressant,which lack of unified diagnostic criteria.OBJECTIVE：To investigate the experience of diagnosis and treatment of ARI following liver transplantation.DESIGN,TIME AND SETTING：The experiment was performed at the 458 Hospital of Chinese PLA from January 2004 to December 2006.PARTICIPANTS：A total of 37 cases received liver transplantation,including 35 males and 2 females,aged 37-67 years,mean aged （48.5±8.9） years.All cases were divided into the liver cancer group （n=16） and liver cirrhosis group （n=21）.The liver cirrhosis group included 16 cases with posthepatitic type B cirrhosis,4 with posthepatitic type C cirrhosis,and 1 with alcoholic cirrhosis.All these cases were in decompensation stage.The final diagnosis was performed by pathological examination.METHODS：The removal of kidney and construction of blood outflow tract was achieved by modified piggy-back liver transplantation.The arterial blood gas analysis,blood routine examination,renal function and liver function were examined more than twice per day.The cephalosporins,Fluconazole and ganciclovir or vancomycin were used for 5-7 days to prevent infections.MAIN OUTCOME MEASURES：The incidence rate of acute ARI,clinical features and outcomes of patients were observed.RESULTS：ARI developed in 19 patients with liver transplantation,5 patients died,14 patients recovered in 2-3 weeks.The incidence of ARI following liver transplantation was associated with infection,bleeding shock,respiratory failure and acute respiratory distress syndrome （P〈0.05）.CONCLUSION：The incidence of ARI following liver transplantation was 51.35%,with 26.32% mortality rate.The early diagnosis and treatment are the key steps for increasing successful rate of ARI treatment following liver transplantation.