活体肝移植术后急性肾损伤的危险因素分析及其与预后的关系

目的 观察活体肝移植术后急性肾损伤（AKI）的发生情况及预后，探讨活体肝移植术后发生AKI的危险因素。 方法 回顾性分析首次行活体肝移植手术的成人患者术前、术中及术后临床资料，根据急性肾损伤网络（AKIN）标准诊断AKI。应用Logistic回归分析活体肝移植患者术后AKI发生的危险因素。应用Kaplan-Meier生存曲线分析患者术后1年的预后，观察AKI对患者预后的影响。 结果 同期220例肝移植患者中，94例为活体肝移植，术后56例出现AKI，发生率为59.6％，其中AKI 1期占31.9%，AKI 2期占12.8%，AKI 3期占14.9%；另其中2例接受肾替代治疗（2/56，3.6％）。AKI患者的1年存活率显著低于非AKI患者（65.0%比96.7%，P < 0.05）。多因素Logistic回归分析显示，术前APACHE II评分（优势比OR=5.126）、术中胶体用量（OR=1.650）、无肝期平均动脉压差值（△MAP）（OR=5.564）是活体肝移植术后发生1期AKI的独立危险因素；术前凝血酶原国际标准化比值（INR）水平（OR=4.940）、术前蛋白尿（OR=3.385）和术中输RBC量（OR=1.752）是活体肝移植术后发生2~3期AKI的独立危险因素。 结论 活体肝移植患者术后AKI发生率高，AKI患者预后较差。关注AKI发生的危险因素可能有助于预防活体肝移植术后AKI的发生，改善患者预后。

Analysis of risk factor of acute kidney injury after living donor liver transplantation and its association with prognosis

Objective To determine the incidence,risk factor and outcome of acute kidney injury (AKI) after living donor liver transplantation (LDLT).Methods Clinical data of adult patients undergone LDLT first were retrospectively analyzed.Acute Kidney Injury Net (AKIN) criteria was applied to define and classify the postoperative AKI.Logistic regression analysis was used to determine the risk factor of AKI.Kaplan-Meier survival curve was used to investigate the association between AKI stage and survival rate.Results Of 220 patients during the period of investigation,94 patients received LDLT.Of these 94 patients,56 patients presented AKI.The incidence of AKI after LDLT was 59.6%,and the percentages of stage Ⅰ,stage Ⅱ and stage Ⅲ AKI were 31.9%,12.8% and 14.9% respectively.Two patients with AKI (3.6%) needed the renal replacement therapy(RRT).One year survival rate of AKI patients was much lower than that of non-AKI patients (65.0% vs 96.7%,P＜0.05).Multivariate Logistic regression analysis showed that preoperative acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score (OR=5.126),the change of mean artery pressure (△MAP) during anhepatic phase (OR =5.564) and colloid transfusion in operation (OR =1.650) were independent risk factors for stage Ⅰ AKI.Preoperative prothrombin international normalized ratio (INR) (OR=4.940),preoperative proteinuria (OR=3.385)and RBC transfusion during operation (OR=1.752) were independent risk factors for stage Ⅱ-Ⅲ AKI.Conclusions Incidence of AKI after LDLT is quite high and the prognosis is poor.Paying close attention to the potential risk factors of AKI may be beneficial to the prognosis of patients.