O'Riordan A, Wong V, McQuillan R, McCormick P A, Hegarty J E, Watson A J
Department of Nephrology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
Am J Transplant. 2007 Jan;7(1):168-76. doi: 10.1111/j.1600-6143.2006.01602.x. Epub 2006 Nov 15.
Acute renal failure (ARF) can complicate up to 60% of orthotopic liver transplants (OLT). The RIFLE criteria were developed to provide a consensus definition for acute renal disease in critically ill patients. Using the RIFLE criteria, we aimed to determine the incidence and risk factors for ARF and acute renal injury (ARI), and to evaluate the link with the outcomes, patient survival and length of hospital stay. Three hundred patients, who received 359 OLTs, were retrospectively analyzed. ARI and ARF occurred post 11.1 and 25.7% of OLTs, respectively. By multivariate analysis, ARI was associated with pre-OLT hypertension and alcoholic liver disease and ARF with higher pre-OLT creatinine, inotrope and aminoglycoside use. ARF, but not ARI, had an impact on 30-day and 1-year patient survival and longer length of hospital stay. ARI and ARF, as defined by the RIFLE criteria, are common complications of OLT, with distinct risk factors and ARF has serious clinical consequences. The development of a consensus definition is a welcome advance, however these criteria do need to be validated in large studies in a wide variety of patient populations.
急性肾衰竭（ARF）可使高达60%的原位肝移植（OLT）出现并发症。制定RIFLE标准是为了对重症患者的急性肾疾病给出一个共识定义。我们旨在使用RIFLE标准确定ARF和急性肾损伤（ARI）的发生率及危险因素，并评估其与患者预后、生存及住院时间的关系。对接受了359例OLT的300例患者进行了回顾性分析。ARI和ARF分别在11.1%和25.7%的OLT术后发生。多因素分析显示，ARI与OLT术前高血压和酒精性肝病相关，而ARF与OLT术前较高的肌酐水平、使用血管活性药物和氨基糖苷类药物有关。ARF而非ARI对30天和1年的患者生存率及更长的住院时间有影响。按照RIFLE标准定义的ARI和ARF是OLT常见的并发症，有不同的危险因素，且ARF有严重的临床后果。制定一个共识定义是一项值得欢迎的进展，然而这些标准确实需要在针对广泛患者群体的大型研究中进行验证。
