肝移植术后早期急性肾功能衰竭的诊断和治疗(附41例回顾性分析)

目的总结肝移植术后早期急性肾功能衰竭的防治经验。方法回顾性分析41例肝移植术后早期肾功能不全的发病机制、治疗方法及效果。结果41例肝移植受者中,死亡14例(34.15%)。术后并发症:肺部感染24例,多器官功能障碍综合征(MODS)13例,腹腔出血6例,急性排斥反应6例,胆道并发症3例,门静脉血栓1例,原发性移植肝无功能1例,全身播散性真菌感染1例。术后2例生存超过5年,4例生存超过4年,7例生存超过3年,11例生存超过2年。结论在背驮式肝移植中行腔-腔静脉侧侧吻合(SSCCA)、采用抗CD25单克隆抗体诱导治疗、降低钙神经蛋白抑制剂用量、实施环孢素C2监测对降低肝移植术后早期急性肾功能衰竭的发生率可能有一定意义,对于出现难以逆转的肾损害同时无法耐受血液透析的受者,肾移植可能是惟一的选择。

Diagnosis and treatment of early acute renal failure after liver transplantation: report of 41 cases

Objective To summarize the experience of prophylaxis and treatment of early acute renal failure associated with liver transplantation(RFALT).Methods The clinical data of 41 adult liver transplant(LT) recipients who were diagnosed as RFALT were analyzed retrospectively.(Results)Among 41 LT recipients,14 patients died postoperatively and the mortality rate was 34.15%.The postoperative complications included pulmonary infection(24 cases),multiple organ dysfunction syndrome(MODS)(13 cases),intraperitoneal bleeding(6 cases),acute rejection(6 cases),bile duct stricture or bile leakage(3 cases),portal thrombosis(1 cases),primary nonfunction of allograft(1 cases),and disseminated fungal infection(1 case).2 patients survived more than 5 years,4 patients more than 4 years,7 patients more than 3 years and 11 patients more than 2 years.(Conclusions) Side-to-side cavo-caval anastomosis in piggy-back technique,induction therapy using anti-CD25 monoclonal antibody,dose reduction or temporary withdraw of calcineurin inhibitors,and implementation of CsA C_2 monitoring might be helpful to decrease the incidence of RFALT.However,for the patients with end-stage renal failure who can't tolerate CRRT,renal transplantation may be the only choice.