Objective: To observe the changes in renal function in patients with severe hepatitis and liver cancer with cirrhosis during orthotopic liver transplantation (OLT).
Methods: Thirty end-stage liver disease patients with normal blood urea nitrogen (BUN) and serum creatinine (SCr) undergoing OLT were studied. They were divided into two groups: severe hepatitis group (group H, n=15) and liver cancer group (group C, n=15), and all the patients received modified piggyback liver transplantation without veno-venous bypass. During the operation, blood samples were drawn for the determination of serum beta (2)-microglobulin (beta (2)-MG), and the determination was performed at 5 following time points: before operation, 20 minutes before anhepatic phase, 30 minutes in anhepatic, 60 minutes after reperfusion, and the end of operation. Urine samples were collected for determination of urine beta (2)-MG and N-acetyl-beta-D-glucosaminidase (NAG) at 3 time points: before operation, 60 minutes after reperfusion, and the end of operation. The values of SCr and BUN before operation, 24 hours after operation and 1 week after operation. The incidence of renal function failure after liver transplantation in the two groups were recorded respectively.
Results: (1)In 7 patients. 12 patients and 14 patients whose serum beta (2)-MG, urine beta (2) MG and urine NAG were higher than normal values, respectively, in group H before operation, and in 3 patients, 3 patients and 7 patients whose serum beta (2)-MG, urine beta (2)-MG and urine NAG, respectively, were higher than normal values in group C before operation. The incidence of abnormal of urine beta (2)-MG and NAG in group H were significantly higher than those in group C (P<0.01, P<0.05 respectively),while there were no significant differences for the abnormal rate of serum beta (2)-MG at every time point between the two groups during operation (all P>0.05). (2)Compared with baseline, serum beta (2)-MG almost had no change in both groups. There were no significant differences in the variation and the mean value of serum beta (2)-MG at every time point between the two groups (all P>0.05). Compared with the baseline,urine beta (2)-MG and urine NAG were increased at 60 minutes after reperfusion and also at the end of operation in both groups, but the differences were not significant (P>0.05). Compared with group C, urine NAG increased at every time point during the operation in group H (P<0.05 or P<0.01). (3)Incidence of renal failure related with liver transplantation (RFALT):46.7% developed RFALT in group H at 24 hours after operation, and there was none in group C(P<0.01).
Conclusion: Compared with patients with liver cancer with cirrhosis,the damages to renal function in patients with severe hepatitis before operation are more serious, which are mainly due to renal tubular injury. These patients are susceptible to RFALT, and protection of renal function is necessary.