Lima Emerson Q, Zanetta Dirce M T, Castro Isaac, Massarollo Paulo C B, Mies Sergio, Machado Marcelo M, Yu Luis
Nephrology Division, University of Sao Paulo, Sao Paulo, Brazil.
Ren Fail. 2003 Jul;25(4):553-60. doi: 10.1081/jdi-120022546.
Acute renal failure (ARF) is a common complication after liver transplantation (LTx). Identification of risk factors may prevent the development and attenuate the impact of ARF on patients outcome after LTX.
Retrospective analysis of variables in the pre, intra, and postoperative periods of 92 patients submitted to LTx was performed in order to identify risk factors for development of ARF after LTx. ARF was defined as serum creatinine > or = 2.0 mg/dL in the first 30 days after LTx. Univariate and multivariate analysis by logistic regression were performed.
ARF group comprised 56 patients (61%). Preoperative serum creatinine was higher in ARF group. During the intraoperative period, ARF group required more blood transfusions, developed more episodes of hypotension and presented longer anesthesia time. In the postoperative period, ARF group presented higher serum bilirubin and more episodes of hypotension. Dialysis was required in 10 patients (11%). The identifled risk factors for development of ARF were: preoperative serum creatinine > 1.0 mg/dL. more than five blood transfusions in the intraoperative period, hypotension during intra and postoperative periods. The identified mortality risk factors were hypotension in the postoperative period and no recovery of renal function after 30 days.
Several factors are involved in the pathogenesis of ARF after LTx and may influence patients outcome and mortality. Pretransplant renal function and hemodynamic conditions in the operative and postoperative periods were identified as risk factors for development of ARF after LTx. Nonrenal function recovery and postoperative hypotension were identified as mortality risk factors after LTx.
急性肾衰竭（ARF）是肝移植（LTx）后常见的并发症。识别风险因素可预防ARF的发生，并减轻其对肝移植患者预后的影响。
对92例行肝移植患者的术前、术中和术后变量进行回顾性分析，以确定肝移植后发生ARF的风险因素。ARF定义为肝移植后30天内血清肌酐≥2.0mg/dL。采用逻辑回归进行单因素和多因素分析。
ARF组有56例患者（61%）。ARF组术前血清肌酐较高。术中，ARF组需要更多输血，发生更多低血压事件，麻醉时间更长。术后，ARF组血清胆红素较高，低血压事件更多。10例患者（11%）需要透析。已确定的ARF发生风险因素为：术前血清肌酐>1.0mg/dL、术中输血超过5次、术中和术后低血压。已确定的死亡风险因素为术后低血压和30天后肾功能未恢复。
肝移植后ARF的发病机制涉及多个因素，可能影响患者的预后和死亡率。移植前肾功能以及手术和术后的血流动力学状况被确定为肝移植后发生ARF的风险因素。肾功能未恢复和术后低血压被确定为肝移植后的死亡风险因素。
