特利加压素对肝移植术后急性肾损伤的影响

摘要/Abstract

摘要： 目的分析围术期输注特利加压素对肝移植术后肾功能的影响。方法回顾分析2020年9月至2022年9月于东部战区总医院进行肝移植的236例患者,根据术中有无持续输注特利加压素分为特利加压素组和对照组。通过倾向评分匹配术前变量,对比术中和术后的临床数据。结果参与分组的224例患者中有87例(38.8%)出现了急性肾损伤。224例患者有89例围术期泵注特立加压素,经过1∶1倾向评分匹配后,共匹配到69对患者。特利加压素组69例患者中有25例(36.2%)出现了急性肾损伤,对照组69例患者中有30例(43.5%)急性肾损伤,两组差异无统计学意义(P>0.05)。两组围术期出血量和输血量无明显差异(P>0.05),特利加压素组围术期尿量为1250(875,1750)mL,明显高于对照组的950(565,1450)mL(P<0.05)。特利加压素组发生严重急性肾损伤3例(4.3%),对照组12例(17.4%)(P<0.05)。结论围术期持续输注特利加压素可以提高围术期尿量,在一定程度上降低严重急性肾损伤的发生率。

关键词: 特利加压素, 肝移植, 肾功能, 急性肾损伤, 倾向评分匹配

Abstract: Objective To analyze the impact of perioperative terlipressin on bleeding and postoperative renal function following liver transplantation. Methods A retrospective analysis was performed on 236 patients who underwent liver transplantation at our hospital from September 2020 to September 2022. Patients were divided into two groups based on whether they received a continuous intraoperative terlipressin infusion: the terlipressin group and the control group. Clinical data from both intraoperative and postoperative periods were compared using propensity score matching to balance preoperative variables. Results Among the 224 patients included in the subgroup analysis, acute kidney injury occurred in 87 (38.8%) individuals. Using 1:1 propensity score matching, 89 patients who received perioperative terlipressin were matched with 69 control patients In the terlipressin group (n=69), 25 patients (36.2%) developed acute kidney injury, which was lower than the 30 patients(43.5%) in the control group (n=69). However, there was no statistical difference between the two groups (P>0.05). There was also no significant difference in perioperative bleeding and blood transfusion rates between the two groups (P>0.05). The perioperative urine volume in the terlipressin group was significantly higher[median: 1250ml, interquartile range: 875 mL-1750 mL] compared to the control group [median: 950ml, interquartile range: 565 mL-1450 mL](P<0.05). For severe acute kidney injury, the terlipressin group had fewer instances(3 cases, 4.3%) compared to the control group(12 cases, 17.4%) (P<0.05). Conclusion Continuous infusion of terlipressin during the perioperative period can significantly enhance perioperative urine output and may potentially reduce the incidence of severe acute kidney injury.

Key words: Terlipressin, Liver transplantation, Renal function, Acute kidney injury, Propensity score matching

徐磊, 曹林, 吴明明, 张燕林, 孙浩. 特利加压素对肝移植术后急性肾损伤的影响[J]. 肝脏, 2023, 28(7): 823-826.

XU lei, CAO Lin, WU Ming-ming, ZHANG Yan-lin, SUN Hao. Effect of terlipressin on acute kidney injury after liver transplantation[J]. Chinese Hepatolgy, 2023, 28(7): 823-826.

参考文献

[1] Thongprayoon C, Kaewput W, Thamcharoen N, et al. Incidence and impact of acute kidney injury after liver transplantation: a meta-analysis. J Clin Med, 2019, 8(372): 1-25.
[2] Qi X, Bai Z, Zhu Q, et al. Practice guidance for the use of terlipressin for liver cirrhosis-related complications. Therap Adv Gastroenterol, 2022, 15: 1-19.
[3] Kandil M A, Abouelenain K M, Alsebaey A, et al. Impact of terlipressin infusion during and after live donor liver transplantation on the incidence of acute kidney injury and neutrophil gelatinase-associated lipocalin serum levels: a randomized controlled trial. Clin Transplant, 2017, 31(8).
[4] Reddy M S, Kaliamoorthy I, Rajakumar A, et al. Double-blind randomized controlled trial of the routine perioperative use of terlipressin in adult living donor liver transplantation. Liver Transpl, 2017, 23(8): 1007-1014.
[5] 夏坤锟, 张水军, 吴阳, 等. 特利加压素对肝移植受者肾功能的影响. 中华器官移植杂志, 2012, 33(8): 488-490.
[6] Abbas M S, Mohamed K S, Ibraheim O A, et al. Effects of terlipressin infusion on blood loss and transfusion needs during liver resection: a randomised trial. Acta Anaesthesiol Scand, 2019, 63(1): 34-39.
[7] Park S, Lee H C, Jung C W, et al. Intraoperative arterial pressure variability and postoperative acute kidney injury. Clin J Am Soc Nephrol, 2020, 15(1): 35-46.
[8] 罗文婷, 曹丽, 吕德珍, 等. 基于PNI、SII、CAR的列线图模型对肝移植术后腹腔感染的预测价值. 器官移植, 2022, 13(04): 503-508.
[9] 夏然, 童兴瑜, 张成密, 等. 术后肺部并发症的围手术期防治策略相关研究进展. 国际麻醉学与复苏杂志, 2020, (04): 370-376.
[10] Skagen C L, Said A. Vasoconstrictor use in liver transplantation: is there evidence for rational use. Minerva Gastroenterol Dietol, 2010, 56(3): 279-296.
[11] Hong S H, Lee J M, Choi J H, et al. Perioperative assessment of terlipressin infusion during living donor liver transplantation. J Int Med Res, 2012, 40(1): 225-236.
[12] Won Y J, Kim H J, Lim B G, et al. Effect of perioperative terlipressin on postoperative renal function in patients who have undergone living donor liver transplantation: a meta-analysis of randomized controlled trials. Transplant Proc, 2015, 47(6): 1917-1925.
[13] Gavriilidis P, Hidalgo E, Sutcliffe R P, et al. Terlipressin versus placebo in living donor liver transplantation. Hepatobiliary Pancreat Dis Int, 2022, 21(1): 76-79.
[14] Kulkarni A V, Kumar K, Candia R, et al. Prophylactic perioperative terlipressin therapy for preventing acute kidney injury in living donor liver transplant recipients: a systematic review and meta-analysis. J Clin Exp Hepatol, 2022, 12(2): 417-427.
[15] Jamil K, Pappas S C, Devarakonda K R. In vitro binding and receptor-mediated activity of terlipressin at vasopressin receptors V(1) and V(2). J Exp Pharmacol, 2018, 10: 1-7.
[16] Dong V, Nadim M K, Karvellas C J. Post-liver transplant acute kidney injury. Liver Transpl, 2021, 27(11): 1653-1664.
[17] Lichtenegger P, Schiefer J, Graf A, et al. The association of pre-operative anaemia with survival after orthotopic liver transplantation. Anaesthesia, 2020, 75(4): 472-478.
[18] Zhou J, Zhang X, Lyu L, et al. Modifiable risk factors of acute kidney injury after liver transplantation: a systematic review and meta-analysis. BMC Nephrol, 2021, 22(1): 149.
[19] Piano S, Gambino C, Vettore E, et al. Response to terlipressin and albumin is associated with improved liver transplant outcomes in patients with hepatorenal syndrome. Hepatology, 2021, 73(5): 1909-1919.