肝移植术后早期急性肾功能衰竭处理及危险因素分析

目的探讨肝移植术后早期急性肾功能衰竭的处理及相关危险因素。方法回顾分析400例肝移植临床资料，观察术后急性肾功能衰竭病人的处理及预后。根据有无肾功能衰竭分组，对13项相关的危险因素进行单因素及多因素分析。结果肝移植术后早期急性肾功能衰竭的发生率为7．2％，均接受持续静脉静脉血液滤过治疗，1年生存率为44．4％。单因素分析中年龄、术前肝功能分级、术前肌酐、尿素氮、手术时间、术中输血量组间差异有统计学意义，多因素分析中只有术前肝功能分级是独立的危险因素。结论肝移植术后早期急性肾功能衰竭预后差，可能与多种诱发因素有关，术前肝功能不全是独立的危险因素。

Treatment of and risk factors for early acute renal failure after orthotopic liver transplantation

Objective To discuss the treatment and identify risk factors for early acute renal failure (ARF) after orthotopic liver transplantation (OLT). Methods The clinical data of 400 patients receiving OLT were retrospectively analyzed to determine the treatment and prognosis of early ARF after OLT. Univariate and stepwise logistic multivariate analyses were performed in different groups for determination of 13 relevant risk factors. Results The incidence of acute ARF was 7. 2% and the continuous veno-venous hemofiltration (CWH) was applied in all those patients whose actuarial 1-year survival rate was 44. 4%. The univariate analysis showed that the age, preoperative Child-Pugh classification, preoperative serum creatinine and blood urea nitrogen values, operative duration and intraoperative transfusion were significantly different between the non-dialysis group and dialysis group. However, only the Child-Pugh classification was identified as the independent risk factor in the multivariate analysis. Conclusions The prognosis of early ARF after OLT is not good. Its etiology is multifactorial and only the pretransplant Child-Pugh classification is an independent risk factor.