The Clinical Practice And Influencing Factors Of CRRT In The Acute Kidney Injury After Liver Transplantation

?Background and Objectives?Postoperative acute kidney injury(AKI)is a common complication that affects the prognosis of patients undergoing liver transplantation,which has high morbidy and mortality.CRRT is an important therapy for postoperative AKI and many problems of its application are not yet clear.The purposes of our study are following:1.To observe the application of CRRT in patients with postoperative AKI.2.To investigate the risk factors for CRRT in postoperative AKI patients.3.To investigate the effects of CRRT on postoperative severe AKI patients and the influencing factors on postoperative 30-day survival rate.?Methods?1.Clinical data and follow-up data of the 381 patients undergoing liver transplantation in our hospital from January 1,2006 to December 31,2016 were retrospectively analyzed and the deadline of follow-up was January 1,2018.We divided the patients into two groups by 2012 to study the differences of the morbidity of AKI,CRRT rate,and mortality.2.Perioperative clinical data of CRRT group(31 cases)and non-CRRT group(227cases)were analyzed to explore the risk factors for postoperative CRRT.The 49 postoperative severe AKI patients were chosen as the research object to investigate the effect of CRRT and the influence of the postoperative 30-day survival rate.3.The CRRT group was divided into two groups: survival group and death group,according to the survival of 30 days after surgery.The clinical data of the two groups and the parameters of CRRT were analyzed to explore the influenceing factors of the survival rate in 30 days postoperatively.?Results?1.The morbidity of postoperative AKI and severe AKI before and after 2012 were65.3% vs 71.0% and 8.7% vs 18.5%,respectively.The total mortality of postoperative30-day and AKI group mortality before and after 2012 were 7.3% vs11.1% and 11.2%vs14.8%,respectively.There was no statistics significance between two groups on above items(P> 0.05).However,the CRRT rate before and after 2012 were 3.7% vs14.2%,respectively,which difference had significance of statistics(P <0.05).2.Compared two groups of perioperative clinical data and performed the univariate analysis.The results showed that the difference of 42 factors between the CRRT group and non-CRRT group had significance of statistics(P <0.05).The 42 factors included MELD score >23 points,preoperative eGFR,intraoperative urine volume,blood loss,vasoactive drug using,intraoperative and postoperative hypotension,intraoperative postoperative blood transfusion,postoperative mechanical ventilation duaration,postoperative MODS,intraperitoneal hemorrhage,and so on.Moreover,CRRT group' s MELD score,intraoperative bleeding,postoperative mechanical ventilation duration were higher than those in non-CRRT group,while CRRT group's preoperative eGFR was lower than that in non-CRRT group.Analyzing of the above indicators with the binary logistic regression analysis,the results showed that: intraoperative bleeding ?5000ml,intraoperative urine volume ? 1000 ml,postoperative mechanical ventilation duration ? 12 h had statistically significant between the two groups(P <0.05).3.The 30-day mortality rate after liver transplantation in CRRT group and non-CRRT group were 61.3% vs 6.2%,respectively,with significant differences(P<0.001).4.The matched analysis of biochemical indicators,coagulation indicators,and 24 h urine volume in pre-CRRT group and post-CRRT group showed that all indicators were improved,especially serum creatinine and urea nitrogen(P<0.05).The postoperative30-day mortality of CRRT group and non-CRRT group in severe AKI patients was61.3% vs 72.2%,and the survival rate was 38.7% vs 27.8%.But the differences had no statistics significance(P>0.05).5.The univariate analysis of the perioperative data and CRRT parameters between survival group and death group showed that: the difference of 36 factors in total had statistics significance(P<0.05),including preoperative blood sodium,intraoperativebleeding,postoperative mechanical ventilation duration,colloidal infusion,RBC insfusion,postoperative hypotension,coagulation function before CRRT,PH,ultrafiltration volume,times of treatment,and so on.Then drawed Kaplan-Meier survival curves and performed log-rank test,the results showed that preoperative sodium levels<135mmol/L,intraoperative bleeding > 5000 ml,postoperative mechanical ventilation duration> 12 h,postoperative hypotension(<90/60mmHg),the mean daily postoperative colloid infusion>1000ml,the mean daily postoperative RBC infusion >1.5U,the pre-CRRT PH value<7.330,the pre-CRRT PT value>20s,the blood flow> 180ml/min and the ultrafiltration rate between 26 and 36ml/(kg·h)had significant differences(P<0.05).?Conclusion?1.The CRRT rate of postoperative AKI patients in our hospital was significantly improved after 2012.2.Intraoperative bleeding ? 5000 ml,intraoperative urine volume ? 1000 ml,postoperative mechanical ventilation duration ? 12 h were independent risk factors for CRRT after surgery.3.CRRT group's condition was more serious than non-CRRT group and its postoperative 30-day mortality was higher than that in non-CRRT group.4.For patients with severe AKI after liver transplantation,CRRT could improve their condition and improve the postoperative 30-day survival rate.5.For severe AKI patients after liver transplantation,8 factors in total were risk factors for 30-day survival rate,which including preoperative hyponatremia,intraoperative bleeding,postoperative hypotension,and so on.While the CRRT blood flow ? 180ml/min and the ultrafiltration rate was between 26 and 36 ml/(kg·h),the30-day survival rate of these patients was improved.