Study On Risk Factors For Acute Kidney Injury After Orthotopic Liver Transplantation

Objective:For the patients of end-stage liver disease,the only potentially curative treatment is liver transplantation currently.The aim of study is to investigate the factors that influence the acute kidney injury after orthotopic liver transplantation(OLT).For those who have risk factors involving kidney injury,timely and appropriate clinical intervention may be benificial to reduce incidence of postoperative acute kidney injury(AKI)and to improve the survival of patients with liver transplantation.Methods:Retrospective analysis of totally 80 cases of orthotopic liver transplantation from January 1,2005 to January 1,2019 in the Organ Transplantation Center of the First Affiliated Hospital of Kunming Medical University.According to whether occurrence of AKI in a week after operation or not,patients were divided into AKI group(n=56)and no AKI group(n=24).Retrospective analysis and comparison of AKI group and non-AKI group were made.Univariate and multivariate analysis were used to investigate the age,preoperative levels of total bilirubin,prothrombin time,albumin level,serum creatinine level,gastrointestinal bleeding,operative time,anhepatic period time,blood loss,blood transfusion volume,urine volume and Dosage of vasoactive drugs in two group.The follow-up results and the clinical data collected were analyzed by SPSS 22.0 software.Qualitative data are expressed by frequency and percentage.Quantitative data are expressed by mean and standard deviation(when it conforms to normal distribution)or median and quartile spacing(when it does not conform to normal distribution).Chi-square test is used for inter-group comparison of qualitative data.Independent sample t test(or rank sum)is used for inter-group comparison of quantitative data.The ROC curve was used to evaluate the diagnostic value of preoperative and intraoperative clinical features for post-operative renal function injury.Logistic regression was available to explore the relationship between multivariate clinical indicators and post-operative renal function injury.The test level was a=0.05.When P<0.05,the difference was statistically significant.Results:This study included 80 eligible subjects,with an average age of 47.98±10.64 years,including 59 males(73.8%)and 21 females(26.3%).According to the level of creatinine within one week after operation,80 patients were divided into renal function injury and non-renal function injury group,of which 46 were renal function injury group(57.5%)and 34 were non-renal function injury group(42.5%).The primary diseases were all end-stage liver diseases,including post-hepatitis B cirrhosis alcoholic cirrhosis,post-hepatitis C cirrhosis,hepatocellular carcinoma,primary biliary cirrhosis,chronic hepatitis B fulminant liver failure,drug-induced subacute liver failure,occult cirrhosis and Budd-Chiari syndrome in 37,6,3,19,7,5,1,1,1 case,respectivly.Conclusions:The total bilirubin,creatinine,and coagulation time in preoperative period,with blood loss,urine volume,blood transfusion volume,red blood cell volume in intraoperative time,as well as upper gastrointestinal bleeding within 2 weeks before operation are the influencing factors of renal function injury after liver transplantation.Preoperative prothrombin time,and intraoperative blood loss are independent risk factors for early renal function injury after orthotopic liver transplantation.