肝移植术后早期急性肾衰竭的危险因素

Analysis of the risk factors related to early acute renal failure after orthotopic liver transplantation

目的分析肝移植术后早期急性肾衰竭(ARF)的危险因素。方法回顾性分析122例肝移植患者的临床资料,对ARF相关的多种危险因素进行Stepwise Logistic回归分析。结果122例肝移植患者术后30d内发生ARF29例(发生率为23.77%),Logistic回归分析显示,术前血红蛋白、胆红素、肌酐和术中尿量为独立危险因素。29例ARF患者中,13例(44.83%)1个月内肾功能恢复正常,13例(44.83%)接受了肾脏替代治疗(RRT),与未发生ARF的对照组比较,ARF组监护室停留时间[(6.17±5.70)dvs(2.02±1.23)d]、死亡率(37.93%vs3.22%)比较差异均有统计学意义(P<0.001)。结论肝移植术后早期ARF是影响患者近期生存的重要因素,术前贫血、血肌酐水平偏高及高胆红素血症是肝移植术后早期ARF的主要危险因素。

Objective To analyse the risk factors related to acute renal failure （ARF） within one month after orthotopic liver transplantation. Methods The clinical data of 122 cases with liver transplantation were analyzed retrospectively. The relationship between multivariate risk factors and early ARF after orthotopic liver transplantation was analyzed by Stepwise Logistic Regression. Results The incidence of ARF within 30 days was 23.77% （ n = 29 ）. Preoperative hemoglobin, total bilirubin, serum creatinine and urine output during the operation were independent predictor of the development of ARF. 13 patients accepted early renal replacement therapy. There were statistical significances in the time staying in intensive care unit [ （ 6.17 ± 5.70 ） days vs （ 2.02 ±1.23 ） days, P 〈 0. 001 ] and mortality during the first month after the operation （ 37.93% vs 3.22, P 〈 0. 001 ） between the patients with ARF and without ARF. Conclusion Early acute renal failure is a key negative factor for the survivors after orthotopic liver transplantation. Preoperative anemia, hyperbilirubinemia, increase of serum creatinine or low urine output during operation are independent risk factors for development of ARF.