Prediction Of Early Acute Kidney Injury After Liver Transplantation With MELD-NA Score

Objective:To investigate the incidence of early acute kidney injury after orthotopic liver transplantation in patients with normal preoperative renal function and Prediction of the incidence of early acute kidney injury(AKI)after liver transplantation by preoperative MELD-NA score.Methods:Retrospective analysis the clinical data of 403 patients with end-stage liver disease undergone liver transplantation in Fuzhou General Hospital Hepatobiliary Surgery Department from January 2005 to February 2015.According to the inclusion and exclusion criteria,315 cases were included in this study.According to the MELD-NA scoring method,the preoperative MELD-NA score of 315 patients was calculated.According to the MELD-NA score results,315 recipients were divided into three groups(A group 115::MELD-NA score ?10,B group 118:MELD-NA score > 10,?20,C group 82:MELD-NA score > 20).According to KDIGO's AKI staging criteria,it was judged whether AKI and its staging in early stage after liver transplantation in 315 recipients.The incidence of acute renal injury was analyzed statistically and preoperative MELD-NA score and the correlation between the AKI staging.Results:A total of 315 liver transplant patients were analyzed.There were 208 cases(64.76%,208/315)of AKI in the early stage of liver transplantation,Among them 112 cases(35.56%,112/155)developed AKI stage 1,53 cases(16.83%,53/155)developed AKI stage 2,39 cases(12.38%,39/155)developed AKI stage 3.According to the MELD-NA score,the incidence of AKI in each group showed: 115 cases of A group,49 cases(42.6%,49/115)developed AKI,40 cases(34.78%,40/115)developed AKI stage 1,7 cases(6.09%,7/115)developed AKI stage 2,2 cases(1.74%,2/115)developed AKI stage 3;118 cases of B group,84 cases(71.19%,84/118)developed AKI,42 cases(35.59%,42/118)developed AKI stage 1,27 cases(22.88%,27/118)developed AKI stage 2,15 cases(12.71%,15/118)developed AKI stage 3;82 cases of C group,71 cases patients(86.59%,71/82)developed AKI,30 cases(36.59%,30/82)developed AKI stage 1,19 cases(23.17%,19/82)developed AKI stage2,22 cases(26.83%,22/82)developed AKI stage 3.The three group of the incidence of postoperative AKI was statistically significant(P <0.05).The incidence of postoperative AKI was compared between the three groups : There was significant difference between group A and group B?group A and group C ? group B and group C(P <0.05).By Spearman rank correlation analysis,There was a positive correlation between the MELD-NA score and the AKI staging(R=0.442).There was a statistically significant difference in the early postoperative acute renal injury between the high and low scores of the MELD-NA score,With the increase of the MELD-NA score,the incidence of early postoperative AKI increased,The higher the AKI staging.Conclusions:Preoperative MELD-NA score is a good indicator of early acute renal impairment after liver transplantation.It can be used not only as an evaluation of preoperative disease,but also an important indicator of acute renal damage after operation.The higher the MELD-NA score before surgery,the higher the incidence of early acute renal injury after liver transplantation,and with the increase of preoperative MELD-NA score,the incidence of early postoperative AKI increased,The higher the AKI staging.