Risk Stratification for Chronic Kidney Disease After Liver Transplant for Metabolic Dysfunction-associated Steatohepatitis (MASH) Cirrhosis: Results From the NailMASH Consortium.

IF 5.3 2区医学 Q1 IMMUNOLOGY

Transplantation Pub Date : 2024-10-22 DOI:10.1097/TP.0000000000005236

Sanjaya K Satapathy, Saleh Elwir, Danielle Brandman, Coleman Smith, Yu Jiang, Jason Vanatta, Nghiem B Ha, Amanda C Cheung, Mamatha Bhat, Pratik Patel, Mohammad S Siddiqui, Mary E Rinella, Kymberly D Watt

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Abstract

Background: Chronic kidney disease (CKD) is a well-recognized complication in patients undergoing liver transplantation (LT), particularly those with metabolic dysfunction-associated steatohepatitis (MASH), a leading cause of cirrhosis in the modern era. This study sought to refine risk stratification for CKD events post-LT in cirrhosis patients with MASH by leveraging baseline renal function at transplant.

Methods: A total of 717 MASH cirrhosis patients who had LT (1997-2017) at 7 US centers (NailMASH Consortium) were analyzed. Patients were categorized by estimated glomerular filtration rate (eGFR) at transplant: low (LGFR, eGFR ≤30 mL/min/1.73 m²), medium (MGFR, eGFR >30-≤60 mL/min/1.73 m²), and high (HGFR, eGFR >60 mL/min/1.73 m²). Time-related eGFR intercepts, slopes, and assessments of advanced-stage CKD (aCKD) events, defined as 2 eGFR levels <30 mL/min/1.73 m² separated by ≥90 d, were examined.

Results: Post-LT, LGFR group showed increased eGFR, whereas the HGFR group experienced a decline. The 3-mo mark was identified as a "reset point," signifying a new reference level, beyond which a different rate of decline was observed. After 3 mo, mean eGFRs of the LGFR group approached MGFRs, whereas the mean eGFR of the HGFR group continued to decrease but remained higher than other groups during a 60-mo follow-up. LGFR patients had significantly higher aCKD probability than MGFR and HGFR groups. Subanalysis at 3 mo post-LT revealed more aCKD events in the LGFR group compared with MGFR and HGFR groups (P < 0.0001).

Conclusions: The study underscores renal impact of LT in MASH cirrhosis, indicating unique eGFR trajectories post-LT tied to baseline eGFR, with a reset point at 3 mo. Monitoring post-LT renal function, especially in those at aCKD risk, is crucial. Renal-sparing immunosuppression may help, regardless of baseline eGFR. Further studies are needed for interventions addressing renal dysfunction of patients with MASH post-LT.

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代谢功能障碍相关性脂肪性肝炎 (MASH) 肝硬化肝移植后慢性肾病的风险分层：NailMASH 联合会的研究结果。

背景：慢性肾脏病（CKD）是肝移植（LT）患者公认的并发症，尤其是那些患有代谢功能障碍相关性脂肪性肝炎（MASH）的患者，MASH是现代肝硬化的主要病因。本研究试图利用移植时的基线肾功能，对患有 MASH 的肝硬化患者进行肝移植后 CKD 事件的风险分层：方法：分析了在美国 7 个中心（NailMASH 联合会）接受 LT 的 717 名 MASH 肝硬化患者（1997-2017 年）。根据移植时的估计肾小球滤过率（eGFR）对患者进行分类：低（LGFR，eGFR ≤30 mL/min/1.73 m²）、中（MGFR，eGFR >30-≤60 mL/min/1.73 m²）和高（HGFR，eGFR >60 mL/min/1.73 m²）。与时间相关的 eGFR 截距、斜率和晚期 CKD（aCKD）事件评估，定义为 2 个 eGFR 水平结果：LT后，LGFR组的eGFR增加，而HGFR组的eGFR下降。3 个月被确定为 "重置点"，标志着一个新的参考水平，超过这个水平后，观察到的下降率有所不同。3 个月后，LGFR 组的平均 eGFR 接近 MGFR，而 HGFR 组的平均 eGFR 继续下降，但在 60 个月的随访期间仍高于其他组。LGFR 患者的 aCKD 概率明显高于 MGFR 组和 HGFR 组。LT 术后 3 个月的子分析显示，与 MGFR 组和 HGFR 组相比，LGFR 组患者发生 aCKD 的概率更高（P 结论：LGFR 组患者的 aCKD 概率明显高于 MGFR 组和 HGFR 组）：该研究强调了 LT 对 MASH 肝硬化患者肾脏的影响，表明 LT 后与基线 eGFR 相关的独特 eGFR 轨迹，在 3 个月时有一个重置点。监测LT后的肾功能至关重要，尤其是那些有aCKD风险的患者。无论基线 eGFR 如何，保肾免疫抑制剂可能会有所帮助。还需要进一步研究如何干预MASH患者LT后的肾功能障碍。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplantation 医学-免疫学

CiteScore

8.50

自引率

11.30%

发文量

1906

审稿时长

1 months

期刊介绍： The official journal of The Transplantation Society, and the International Liver Transplantation Society, Transplantation is published monthly and is the most cited and influential journal in the field, with more than 25,000 citations per year. Transplantation has been the trusted source for extensive and timely coverage of the most important advances in transplantation for over 50 years. The Editors and Editorial Board are an international group of research and clinical leaders that includes many pioneers of the field, representing a diverse range of areas of expertise. This capable editorial team provides thoughtful and thorough peer review, and delivers rapid, careful and insightful editorial evaluation of all manuscripts submitted to the journal. Transplantation is committed to rapid review and publication. The journal remains competitive with a time to first decision of fewer than 21 days. Transplantation was the first in the field to offer CME credit to its peer reviewers for reviews completed. The journal publishes original research articles in original clinical science and original basic science. Short reports bring attention to research at the forefront of the field. Other areas covered include cell therapy and islet transplantation, immunobiology and genomics, and xenotransplantation.