A Single-center Clinical Study Of Early Acute Kidney Injury After Classical Orthotopic Liver Transplantation

Objective:To retrospectively analyze the data related to classic orthotopic liver transplantation donors and recipients,and to explore the possible risk factors for AKI complications after classic orthotopic liver transplantation,so as to provide a clinical basis for the perioperative management of liver transplantation,postoperative AKI prevention and treatment.Methods:(1)Data source: 105 patients undergoing classic orthotopic liver transplantation at the Second Affiliated Hospital of Hainan Medical College between November 2019 and November 2022.(2)Inclusion and exclusion criteria: Inclusion criteria:(1)age ≥ 18 years;(2)first liver transplantation;(3)surgical procedure was classic orthotopic liver transplantation;(4)Patients with sufficient preoperative assessment and no absolute contraindications to surgery.Exclusion criteria:(1)patients with s secondary liver transplantation;(2)patients with combined multiple organs transplantation(e.g.combined liver and kidney transplantation,pancreas transplantation,etc.);(3)patients who died within 7 days after surgery;(4)patients with preoperative renal disease(serum creatinine >133 μmol/L).(3)Study grouping: 105 cases were included and their donor data(age,gender,height,weight,BMI,ALT,AST,TBIL,DBIL,IBIL,ALB,SCr,BUN);recipient general data(age,gender,BMI,type of primary disease);previous medical history data(history of abdominal surgery,history of hypertension,history of diabetes);preoperative assessment data(PT,INR,APTT,TT,FIB,PTA,TBIL,DBIL,IBIL,ALB,SCr,BUN,MELD score);perioperative related data(duration of surgery,cold ischemia time,anhepatic phase,intraoperative blood loss,intraoperative red blood cell transfusion,intraoperative plasma transfusion,intraoperative urine volume).According to the KDIGO criteria for AKI diagnosis and staging,105 recipients were divided into AKI group(n=66)and non-AKI group(n=39).(4)Immune induction and immune suppression regimen: All subjects were given20 mg of balliximab for injection during liver transplantation and on the 4th day after surgery,and 500 mg of methylprednisolone was given intravenously during the operation for receptor antibody clearance and immune induction.All recipients were routinely treated with glucocorticoid + tacrolimus + mycophenolic acid triple immunosuppressive regimen after surgery.The dosage was adjusted after operation according to the serum concentration of tacrolimus.(5)SPSS 20.0 was used for statistical analysis.T-test was used to analyze measurement data conforming to normal distribution,and rank sum test was used to analyze measurement data non-normal distribution.The chi-square test was used to compare the data groups.Whether patients were complicated with postoperative AKI was taken as the dependent variable,univariate logistic comparison was carried out between groups,and factors influencing AKI in univariate analysis were selected as independent variables to be included in the model,and multivariate logistic regression analysis was carried out.The ROC curve was used to evaluate the diagnostic value of the time without liver.All statistical test levels were bilateral tests,and P<0.05 was considered statistically significant.Results:(1)Incidence: Of the 105 patients receiving classical orthotopic liver transplantation,66 patients developed AKI within 7 days after surgery,with an incidence of 62.86%(66/105).Among them,46 patients had AKI stage 1,accounting for 69.70%,10 patients had AKI stage 2,accounting for 15.15%,and 10 patients had AKI stage 3,accounting for 15.15%;(2)The effect of donor quality on AKI: age(52 vs 50.5 years,P=0.294),sex(71.8%vs 75.76%,P=0.653),BMI(23.88 kg/m2 vs 22.95 kg/m2,P=0.449),ALT(28 U/L vs33.5 U/L,P=0.450),AST(40 U/L vs 43 U/L,P=0.472),TBIL(12.8 μmol/L vs 15.5μmol/L,P=0.444),DBIL(4.4 μmol/L vs 5.5 μmol/L,P=0.230),IBIL(8.68 μmol/L vs9.90 μmol/L,P=0.884),ALB(35.8 g/L vs 37.6 g/L,P=0.553),SCr(72.0 μmol/L vs95.5 μmol/L,P=0.185),and BUN(6.34 mmol/L vs 6.53 mmol/L,P=0.593)were not statistically significant in the donor data collected in the AKI and non-AKI groups;(3)The differences were statistically significant in age(49 vs 56 years,P=0.028),history of abdominal surgery(21.21% vs 5.13%,P=0.027),preoperative serum creatinine(62.5 μmol/L vs 73 μmol/L,P=0.008),duration of surgery(494 min vs 445 min,P=0.048),anhepatic phase(59 min vs 50 min,P<0.001),and intraoperative plasma transfusion volume(1000 ml vs 600 ml,P=0.005)were statistically significant(P<0.05);(4)Single factor,two classification,logistic regression analysis: Age and preoperative serum creatinine levels were negatively correlated with AKI in classic orthotopic liver transplantation recipients(P<0.05),while abdominal surgery history,surgical time,anhepatic phase,and intraoperative plasma transfusion volume were positively correlated with AKI in classic orthotopic liver transplantation recipients(P<0.05);(5)Multivariate logistic regression analysis showed that a history of abdominal surgery(OR=5.803,95% CI=1.008,33.401,P=0.049),anhepatic phase(OR=1.054,95%CI=1.008,1.101,P=0.020),and preoperative serum creatinine level(OR=0.968,95%CI=0.943,0.994,P=0.016)were independent risk factors for AKI in classic orthotopic liver transplantation recipients;(6)The ROC curve analysis showed that the area under the curve(AUC)for predicting AKI in liver transplantation recipients during anhepatic phase was 0.723(P<0.05),which had a good predictive value.Conclusions:(1)The incidence of AKI in classic orthotopic liver transplantation recipients is high.(2)Previous abdominal surgery history,longer anhepatic phase,and lower preoperative serum creatinine levels are independent risk factors for AKI in classic orthotopic liver transplantation recipients.(3)Anhepatic phase has a good predictive value in predicting the incidence of AKI in liver transplantation recipients.