DCD供肝肝移植术后早期急性肾损伤相关危险因素分析

摘要

Objective To analyze the risk factors of early acute kidney injury (AKI) after liver transplantation from donation after cardiac death(DCD) donor liver. Methods Clinical data of 184 donors and recipients undergoing liver transplantation from DCD donor liver were retrospectively analyzed. According to the incidence of early AKI, all participants were divided into the AKI and non-AKI groups. The patients in the AKI group were subject to AKI staging. Baseline data, preoperative, intraoperative and postoperative related parameters were statistically compared between two groups. The cumulative survival rate and clinical prognosis of patients in non-AKI group and AKI group with different staging were statistically analyzed by Kaplan-Meier curve analysis. Results Among 184 patients, 68 cases (37.0%) presented with early AKI after liver transplantation including 31 stage 1 AKI, 26 stage 2 AKI and 11 stage 3 AKI, mainly occurring within postoperative 3 d. Univariate analysis revealed that preoperative levels of albumin <35 g/L, preoperative levels of serum sodium ≤137 mmol/L, operation time>7.5 h, intraoperative hemorrhage volume>3 000 mL, intraoperative red cell infusion volume>15 U and intraoperative urine amount ≤100 mL/h were the risk factors of early AKI after liver transplantation (all P<0.05). Multi-variate Logistic regression analysis demonstrated that intraoperative red cell infusion >15 U was an independent risk factor of early AKI after liver transplantation [odds ratio(OR) 1.061, 95% confidence interval(CI)1.008-1.118,P=0.024].Result of Kaplan-Meier survival curve suggested that the cumulative survival rate was gradually reduced along with the aggravation of AKI with statistical significance (all P<0.05). Conclusions The incidence of early AKI following liver transplantation is relatively high. The severity of early AKI is intimately correlated with the short- and long-term prognosis of the recipients. A large quantity of intraoperative red blood cell infusion is an independent risk factor of AKI.%目的 分析心脏死亡器官捐献(DCD)供肝肝移植术后早期急性肾损伤(AKI)的相关危险因素.方法 回顾性分析184例DCD供肝肝移植供、受体资料.根据术后早期是否发生AKI分为AKI组和非AKI组,并且对AKI组行AKI分期.比较两组一般资料和术前、术中、术后相关指标的差异.用Kaplan-Meier曲线分析非AKI组和AKI组不同分期累积存活率等预后情况.结果 本研究纳入病例184例,术后早期发生AKI 68例(37.0%),其中AKI 1期31例,AKI 2期26例,AKI 3期11例,且发生多在术后3 d内.单因素分析结果显示术前白蛋白<35 g/L、术前血清钠≤137 mmol/L、手术时间>7.5 h、术中出血量>3000 mL、术中红细胞输注量>15 U、术中尿量≤100 mL/h这6项指标为肝移植术后早期发生AKI的危险因素(均为P<0.05).Logistic多变量回归分析结果表明术中红细胞输注量>15 U是肝移植术后早期发生AKI的独立危险因素[比值比(OR)1.061, 95%可信区间(CI)1.008~1.118,P=0.024].Kaplan-Meier生存曲线结果表明随着AKI程度不断加重,其累积存活率逐渐降低,差异有统计学意义(均为P<0.05).结论 肝移植患者术后早期AKI的发生率较高,且严重程度与受体的短期和长期预后密切相关,术中大量输注红细胞是AKI发生的独立危险因素.