心脏死亡器官捐献肝移植术后并发急性肾损伤危险因素分析

目的探讨心脏死亡器官捐献(DCD)肝移植术后并发急性肾损伤(AKI)的危险因素。 方法回顾性分析2012年1月至2018年11月宁波市医疗中心李惠利医院肝胆胰外科159例DCD肝移植受者临床资料，根据改善全球肾脏病预后组织临床实践指南中AKI诊断标准将159例受者分为AKI组(34例)和对照组(125例)。采用两独立样本t检验比较两组受者年龄和术前血清白蛋白。采用Wilcoxon符号秩和检验比较两组受者术前终末期肝病模型(MELD)评分、术前体质指数(BMI)、供肝冷/热缺血时间、术中输液量、术中出血量、术中输血量、术中尿量、手术时间、术中去甲肾上腺素总用量及总住院天数。采用卡方检验比较两组受者性别、术前乙型肝炎、术中低血压、术后感染、肝移植术式及术后再次手术情况。将单因素分析中有统计学差异的变量纳入Logistic回归进行多因素分析。P<0.05为差异有统计学意义。 结果肝移植术后AKI发生率为21.4%(34/159)。单因素分析结果表明，AKI组与对照组受者术前MELD评分、术前血清白蛋白、术中输液量、术中出血量、术中尿量、手术时间、术中低血压及术后再次手术差异均有统计学意义(Z＝2.763, t＝－2.250, Z＝2.040, Z＝2.092, Z＝－3.303, Z＝－2.170, χ²＝8.227, χ²＝5.294, P均<0.05)。Logistic回归多因素分析结果显示：术前MELD评分、术前血清白蛋白、术中尿量和手术时间是DCD肝移植术后并发AKI的独立危险因素，差异均有统计学意义(P均<0.05)。 结论DCD肝移植术前应改善受者一般情况，提高围手术期营养水平，术中控制液体出入量，合理使用利尿剂和缩短手术时间，以降低受者术后AKI发生率。

Analysis of risk factors for acute kidney injury after donation after cardiac death liver transplantation

ObjectiveTo explore the risk factors of acute kidney injury (AKI) after donation after cardiac death (DCD) liver transplantation. MethodsA retrospective analysis of clinical data of 159 DCD liver transplant recipients from the Department of Hepatobiliary and Pancreatic Surgery at Li Huili Hospital of Ningbo Medical Center from January 2012 to November 2018 was performed. The recipients were divided into AKI group (34 cases) and control group (125 cases) according to the criteria of Kidney Disease: Improving Global Outcomes. Two independent sample t test was used to compare the age and serum albumin before transplantation of the 2 groups. Wilcoxon signed rank sum test was used to compare the preoperative model for end-stage liver disease (MELD) score, preoperative body mass index (BMI), donor liver cold/warm ischemic time, intraoperative infusion volume, intraoperative bleeding volume, and intraoperative intermediate blood transfusion, intraoperative urine output, operation time, total intraoperative norepinephrine dosage and total hospital stay. Chi-square test was used to compare the gender, preoperative hepatitis B, intraoperative hypotension, postoperative infection, liver transplantation method and postoperative reoperation. The variables with statistical difference in univariate analysis were included in Logistic regression for multivariate analysis. P<0.05 was considered statistically significant. ResultsThe incidence of AKI after liver transplantation was 21.4% (34/159). Univariate analysis showed that the indexes including the preoperative MELD score, preoperative serum albumin, intraoperative infusion volume, intraoperative blood loss, intraoperative urine volume, surgical time, intraoperative hypotension and postoperative reoperation between the 2 groups had statistical significance (Z=2.763, t=-2.250, Z=2.040, Z=2.092, Z=-3.303, Z=-2.170, χ²=8.227, χ²=5.294, P all <0.05). Logistic regression multivariate analysis showed the indexes including the preoperative MELD score, preoperative serum albumin, intraoperative urine volume and operation time were independent risk factors for AKI after DCD liver transplantation, and the differences were statistically significant (P all<0.05). ConclusionsFor DCD liver transplantation, the general condition of the recipient before transplantation and the nutritional level during the perioperative period should be improved, and the amount of fluid should be controlled during the operation, the use of diuretics and the operation time should be shortened to reduce the incidence of AKI after transplantation.