Risk Factors For Acute Kidney Injury After Pediatric Liver Transplantation

Objective: investigate the risk factors of acute kidney injury(AKI)after liver transplantation in children,to provide reference for the prevention and treatment of AKI after liver transplantation.Methods: The data of pediatric liver transplantation patients in the first affiliated hospital of guangxi medical university from July 2017 to November 2018 were retrospectively analyzed.AKI group(group B).General data,preoperative,intraoperative and postoperative clinical data of the two groups were statistically analyzed.Results: among the 31 cases,17 were in group A,6 were male and11 were female.There were 14 cases in group B,including 7 males and7 females.Age(group A: 7(5-106)months;group B: 9(5-75)months P=0.632);height(group A: 65(62-138)cm;group B: 66(60-122)cm P=0.720).Body weight(group A 7(5.4-28.5)kg,group B 7.2(5.5-23)kg P=0.952);BMI(group A 15.6(13.18-18.93),group B 16.4(14.78-18.81),P=0.341);BSA(0.345 ?(0.29,1.10)in group A,group B 0.352 ?(0.29,0.91)P = 0.952);PELD score(group A: 7.76 ±10.75,group B: 7.29±9.38,P = 0.897),TBiL(group A: 199.87 ±196.1 umol/L,group B:112.97± 83.17 umol/L,P = 0.160),and propagated(group A: 40.3 ± 6.5g/L,group B: 38.2 ±3.9 g/L,P = 0.300),the INR(group A: 1.29 ± 0.49,group B: 1.21 ± 0.37,P = 0.647)and Scr(group A: 18.25±6.91 umol/L,B: 14.57 ± 5.87 umol/L,P = 0.311),DBiL,ALT,AST,HB,PLT,PT and INR,APTT,FIB,UREA,UA,Ccr,Cys,there was no statistically significant difference compared with preoperative infection(P > 0.05);Vena cava occlusion time(group A: 30±16min,group B: 42±18min,P=0.06),cold ischemia time(group A: 135±66min,group B: 169±82min,P=0.208),hot ischemia time(group A :10±8min,group B :11±7min,P=0.903),blood loss(group A: 621±435ml,group B: 982±1168ml,P=0.246),donor liver weight to recipient weight ratio(GRBW),donor liver volume/recipient standard liver volume(GV/SLV),and the use of the booster drug showed no statistically significant difference between the two groups(P>0.05);Postoperative(FK506 blood concentration,ICU time and hospital stay time)showed no significant difference(all P values were >0.05).The operative time in group A(653±205min)was significantly shorter than that in group B(852±299min),P=0.037 was statistically significant.The time of hepat-free stage A(57±15min)was shorter than that of B(73±20min),P=0.021,Statistically significant difference.Conclusion:The incidence of AKI after liver transplantation in children was 45.2%.Surgical duration and hepat-free period are closely related to the occurrence of AKI after pediatric liver transplantation.The improvement of surgical techniques and the optimization of surgical procedures can shorten the duration of surgery and hepat-free period,which is conducive to the prevention of AKI.