成人肝移植术后早期急性肾损伤危险因素分析

Analysis of risk factors of early acute kidney injury in adults after liver transplantation

目的观察肝移植受者术后早期出现急性肾损伤(AKI)的情况,分析AKI发生的危险因素.方法收集安徽医科大学第一附属医院2015年2月到2020年1月肝移植受者共70例的相关资料,排除移植年龄未满18岁、既往接受过脏器移植、术前已合并肾损害患者9例,根据肝移植术后7d内是否发生AKI将患者进行分组,其中AKI组(35例),非AKI组(26例),对两组患者术前、术中、术后可能导致AKI发生的相关危险因素进行分析.结果在纳入的61例患者中,术后早期AKI的发生率为57.3%,中位发生时间为术后第一天,其中AKI1期18例(57.4%),AKI2期7例(20.0%),AKI3期10例(28.6%),行CRRT替代治疗4例,AKI组患者术前INR值、术前肌酐、术中出血量及术后APACHE II评分明显高于非AKI组患者(P<0.05).多因素回归分析提示术中出血量>1150ml(HR=4.839,P=0.016)及术后APACHE II评分>11(HR=0.3.926,P=0.029)是术后早期发生AKI的独立危险因素.AKI组住ICU时间及28天死亡率较非AKI组升高(P<0.05).结论肝移植受者术后早期AKI发生率较高,AKI组死亡率较非AKI组高,关注并预防诱发AKI发生的危险因素可能有助于减少AKI的发生,改善肝移植受者预后.

Objective To anlyse the incidence of early postoperative acute kidney injury(AKI) in patients who received liver transplantation and to analyze the risk factors for early AKI after liver transplantation. Methods The clinical data of 70 patients who received live transplantation in the Hospital of Anhui Medical University from February 2015 to January 2020 were collected and analyzed. 9 patients who are younger than 18 years old, or once received organ transplantation or have diagnosed of kidney injury before surgery were excluded. The other patients were grouped according to whether AKI occurred within 7 days after liver transplantation, including 35 patients in the AKI group and 26 patients in the non-AKI group. Partial risk factors that may cause AKI before, during, after surgery were analyzed in the two groups. Results In included the 61 cases of patients, the incidence of early postoperative AKI was 57.3%, the median time is the first postoperative day, AKI1 period 18 cases(57.4%), AKI2 period 7 cases(20%),AKI3 period 10 cases(28.6%), 4 cases received CRRI replacement therapy after surgery. Preoperative INR, preoperative creatinine, intraoperative blood loss and postoperative APACHE II score in AKI group were significantly higher than those in non-AKI group(P<0.05).Multivariate regression analysis suggested that intraoperative blood loss >1150 ml(HR= 4.839,P=0.016) and postoperative APACHE II score >11(HR=0.3926,P=0.029) were independent risk factors for early postoperative AKI Duration of ICU stay and 28天 mortality in AKI group were higher than those in non-AKI group(P<0.05). Conclusion The incidence of early AKI after liver transplantation is high and the mortality of AKI group is higher than that of non-AKI group. Attention and prevention the risk factors of early AKI may help reduce the occurrence of AKI and improve the prognosis of liver transplantation patients.