Acute Kidney Injury Following Liver Transplantation:incidence,risk Factors,and Effects On Patient And Kidney Outcomes

【Background and Objectives】Acute kidney injury is one of the common complications after liver transplantation.The mechanism of its occurrence is complex and there are many influencing factors.It is one of the predictors of poor prognosis of liver transplant patients.This study was to investigate the incidence of AKI after liver transplantation,the risk factors of perioperative period,and its influence on the prognosis of the patients,in order to guide the clinical management of perioperative patients with liver transplantation,improve the postoperative renal function,and reduce Long-term mortality after surgery.【Methods】Retrospective case-control studies were conducted on adult patients undergoing liver transplantation at the Organ Transplantation Center of Fuzhou General Hospital from January 1,2006 to December 31,2016.The diagnosis of AKI is according to the KDIGO standard.Through analyzing the preoperative,intraoperative and postoperative parameters of postoperative AKI and non-AKI patients,the incidence,risk factors and prognosis of AKI after liver transplantation are explored.【Results】Of the 381 patients,258(67.7%)developed AKI within 30 days after liver transplantation,of which 105(27.6%)were AKI-1,70(18.4%)were AKI-2,and 83 were AKI-3(21.8%),AKI 1~ 2 accounts for 67.8% of all AKI patients.Of the 258 patients with AKI,55(14.4%)were oliguric,203(53.3%)were non-oliguric,non-oliguric accounts for 78.7% of all AKI patients.There were 246 cases(64.6%)of AKI in the early postoperative period,accounting for 95.3% of all postoperative AKI patients;and there were 12 cases(3.1%)of late AKI postoperatively,accounting for only 4.7% of all postoperative AKI patients.The preoperative factors affecting postoperative AKI by univariate analysis were: age,primary disease liver cancer,hepatic encephalopathy,MELD score,Child-Turcotte-Pugh score,Charlson comorbidity score,preoperative diabetes,vasoactive drugs’ s use,infusion of human albumin,blood transfusion,the level of preoperative BUN,STB,CB,PT,APTT and platelet,preoperative arterial blood Pa CO2,above all totally 17 items(P<0.05).The intraoperative factors by univariate analysis include blood loss,transfusion of suspended red blood cells,fresh frozen plasma,platelet,cryoprecipitate,total urine volume,urine volume of preanhepatic and anhepatic,duration of norepinephrine use,use of cephalosporin antibiotic,cyclophosphamide and recombinant human coagulation factor VIIa,hemorrhage,hypotension and low CVP totaled 15 items(P<0.05).Multivariate analysis showed that Child-Turcotte-Pugh score grade C(OR 6.8,95% CI 1.3~34.3,P=0.020),preoperative use of vasoactive drug(OR value 7.6,95% CI 1.0~56.9,P=0.049),preoperative level of blood BUN ≥ 5mmol/L(OR 2.2,95% CI 1.1~4.7,P=0.036),preoperative APTT ≥ 55s(OR 8.5,95% CI 1.4 ~ 52.3,P=0.021),intraoperative total urine volume ≤1000 m L(OR value 3.0,95% CI 1.1~8.2,P=0.032)and intraoperative hemorrhage(OR value 5.6,95% CI 1.5~21.1,P=0.011)a total of 6 items were independent risk factors for AKI after liver transplantation,and intraoperative use of cephalosporins(OR 0.3,95% CI 0.2~0.6,P=0.001)and cyclophosphamide(OR 0.3,95% CI 0.1~0.6,P=0.001)were independent protective factor for postoperative AKI.Patients with AKI after liver transplantation had more postoperative blood transfusion,more infusion of colloid fluid and human albumin,more postoperative complications,higher incidence of severe renal impairment at the time of 30 days after surgery,lower survival rate within 2 years after surgery(P<0.05).Furthermore,the long-term survival rates after liver transplantation of AKI-3 patients were also significantly reduced(P<0.001).【Conclusion】AKI is a common complication after liver transplantation.Child-Turcotte-Pugh score grade C,preoperative use of vasoactive drug,preoperative level of blood BUN ≥ 5mmol/L,preoperative APTT ≥ 55 s,intraoperative total urine volume ≤ 1000 m L and intraoperative hemorrhage totaling six variables were independent risk factors for postoperative AKI.While intraoperative use of cephalosporins and cyclophosphamide were independent protective factors for postoperative AKI.Patients with AKI after liver transplantation have many early complications and poor prognosis.Therefore,we should pay attention to the interventions of the risk factors of AKI,in order to reduce the risk of postoperative AKI and improve the prognosis.