摘要
目的探讨肝硬化合并肝肾综合征（HRS）患者肝移植的预后及其影响因素。方法随访统计73例成人肝硬化合并HRS患者肝移植的临床资料。采用回顾性研究，收集供、受者的基本信息、手术资料，分析受者术后存活状况。根据术后肾功能是否好转将受者分为好转组（41例）和未好转组（32例），绘制Kaplan-Meier生存曲线对受者肝移植术后1、3、5年累积存活率进行分析。结果两组受者在年龄、病因、Child-Pugh评分等资料的差异均无统计学意义（P〉0．05）。两组术中供肝冷缺血时间、热缺血时间、无肝期等资料的比较，差异均无统计学意义（P〉0．05）。未好转组受者术前终末期肝病模型（MELD）评分高于好转组（P〈0．05）。未好转组术前血肌酐水平为（384．2±38．O）μmol／L，明显高于好转组的（296．2±25．8）μmol／L，差异有统计学意义（P〈0．05）。73例受者均获得随访，随访率达100％，好转组受者术后1、3、5年累积存活率分别为87．8％、82．9％和61％，未好转组分别为56．3％、50％和43．8％，好转组均显著高于未好转组（P〈0．05）。结论术前血肌酐水平和MELD评分显著影响肝硬化合并HRS患者肝移植术后肾功能的转归及预后。肝移植作为治疗肝硬化合并HRS最有效的方法，可使患者获得较理想的长期存活结果。
Objective To investigate the clinical outcomes of patients with cirrhosis and hepatorenal syndrome （HRS） who received a liver transplantation, and analyze factors relevant to renal outcome and survival prognosis. Method Seventy-three cases of adult patients undergoing liver transplantation for cirrhosis and HRS were followed up. The information on demographics of patients and surgical materials were retrospectively collected, and the living conditions after liver transplantation were analyzed. Forty-one patients ultimately having a reversal of HRS after liver transplantation served as HRS- group, and the remaining 32 patients without a reversal of HRS as HRS＋ group. 1-, 3-, and 5-year cumulative survival rate was analyzed after liver transplantation. 73 cases of adult patients underwent liver transplantation for cirrhosis and HRS were followed up in Oriental Organ Transplant Center of Tianjin First Central Hospital. Retrospectively collected information on patient demographics, surgical materials, HRS reversal and living conditions. 41 patients （56. 20/00） ultimately had a reversal of HRS after liver transplantation were placed in HRS- group, while the other 32 patients didn＇t, and therefore remaining in HRS＋ group. 1-, 3-, 5-year cumulative survival rates were analyzed after liver transplantation. Result HRS＋ group had a significantly higher pretransplant serum creatinine level and model for end-stage liver disease （MELD） score than HRSgroup （P〈0. 05）. 1-, 3-, and 5-year cumulative survival rate in HRS＋ group was 56.3%, 50% and 43.8%, significantly higher than in HRS- group （87.8%, 82.9% and 61% respectively, P〈0. 05）. Conclusion Increased pretransplant serum creatinine level and MELD score significantly predict the HRS non-reversal. Patients can obtain a comparatively ideal long-term survival after liver transplantation.
出处
《中华器官移植杂志》
CAS
CSCD
2015年第9期531-535,共5页
Chinese Journal of Organ Transplantation
基金
国家高技术研究发展（863）计划（2012AA021001）
国家自然科学基金（81270554）
器官移植科国家重点临床专科建设项目（201354409）
天津市应用基础研究计划面上项目（05YFJMJC14800）
关键词
肝硬化
肝肾综合征
肝移植
预后
Cirrhosis
Hepatorenal syndrome
Liver transplantation
Prognosis
