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首页> 外文期刊>Critical care medicine >Renal protection during liver transplantation: An ounce of prevention is worth a pound of cure.
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Renal protection during liver transplantation: An ounce of prevention is worth a pound of cure.

机译：肝移植期间的肾脏保护：一盎司的预防值得一磅的治疗。

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摘要

Acute renal dysfunction is a frequent and ominous complication after orthotopic liver transplantation (OLT), with an incidence ranging between 4% and 94%, depending on the definition criteria used. Its origin is multifactorial, and risk factors include recipient pretransplant status and preexisting renal impairment and perioperative hemodynamic instability, as well as significant intraoperative bleeding and use of blood products (1,2). More subtle mechanisms, such as the proin-flammatory mediators and potent reactive oxygen and nitrogen species released from the reperfused liver graft, may lead to leukocyte and endothelial activation and subsequent injury in remote organs, including the glomerular endothelium (3). In addition, endothelial dysfunction and the imbalance between vasodilatatory (i.e., depleted nitric oxide) and vasocon-strictive (the renin-angiotensin system) factors may further aggravate the renal dysfunction. In the longer term, one should also consider the nephrotoxicity of the calcineurin inhibitors, the mainstay of the current immunosuppression.
机译：急性肾功能不全是原位肝移植（OLT）后的常见且不祥的并发症，根据所用的定义标准，其发生率在4％至94％之间。它的起源是多因素的，危险因素包括接受者的移植前状态，既往肾功能不全和围手术期血流动力学不稳定，以及术中大量出血和使用血液制品（1,2）。从再灌注肝移植物中释放的更微妙的机制，如促炎性前体介质和有效的活性氧和氮，可能导致白细胞和内皮细胞的活化以及随后对远端器官（包括肾小球内皮）的损伤（3）。另外，内皮功能障碍以及血管扩张（即一氧化氮消耗）和血管收缩（肾素-血管紧张素系统）因子之间的失衡可能进一步加重肾功能障碍。从长远来看，人们还应该考虑钙调神经磷酸酶抑制剂的肾毒性，而钙调神经磷酸酶抑制剂是目前免疫抑制的主要手段。

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