Zhu M, Li Y, Xia Q, Wang S, Qiu Y, Che M, Dai H, Qian J, Ni Z, Axelsson J, Yan Y
Renal Division, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Transplant Proc. 2010 Nov;42(9):3634-8. doi: 10.1016/j.transproceed.2010.08.059.
Acute kidney injury (AKI) is a major complication in orthotopic liver transplantation (OLT). In an evaluation of Acute Kidney Injury Network (AKIN) criteria in liver transplanted patients, we retrospectively analyzed the usefulness of these criteria to predict survival of 193 consecutive patients at a single center who underwent primary OLT for clinical parameters and peak AKI. Postoperative AKI according to AKIN occurred in 60.1% of the patients, namely, stages 1, 2, and 3 in 30%, 13% and 17.1% respectively. Using multivariate logistic regression, AKIN stage 1 and 2 AKI were independently associated with the pre-OLT Model for End-Stage Liver Disease (MELD) score and age, while stage 3 AKI was independently associated with MELD and Acute Physiology and Chronic Health Evaluation (APACHE) II scores. The 28-day and 1-year mortality post-OLT of AKI patients were 15.5% and 25.9% respectively compared with 0% and 3.9% among non-AKI patients (P < .05 for both). The survival rates of non-AKI and stages 1, 2, and 3 AKI subjects were 96%, 85.5%, 84%, and 45.3%, respectively. Cox regression analysis showed independent risk factors for mortality during the first year after transplantation to include post-OLT AKI (12.1; P < .05), post-OLT infection (HR 4.7; P < .01), pre-OLT hypertension (HR 4.4; P < .01) hazard ratio [HR] and post-OLT APACHE II ≥10 (HR 3.6; P < .05). We concluded that AKI as defined by the AKIN criteria is a major complication of OLT linked to a poor outcomes. It remains to be evaluated whether aggressive perioperative therapy to prevent AKI can improve survival among OLT patients.
急性肾损伤（AKI）是原位肝移植（OLT）的主要并发症。在一项对肝移植患者急性肾损伤网络（AKIN）标准的评估中，我们回顾性分析了这些标准对预测在单一中心接受初次OLT的193例连续患者临床参数和AKI峰值的生存情况的实用性。根据AKIN标准，术后AKI发生在60.1%的患者中，即1期、2期和3期分别为30%、13%和17.1%。使用多因素逻辑回归分析，AKIN 1期和2期AKI与OLT前终末期肝病模型（MELD）评分和年龄独立相关，而3期AKI与MELD和急性生理与慢性健康状况评估（APACHE）II评分独立相关。AKI患者OLT术后28天和1年死亡率分别为15.5%和25.9%，而非AKI患者分别为0%和3.9%（两者P均<0.05）。非AKI患者以及AKI 1期、2期和3期患者的生存率分别为96%、85.5%、84%和45.3%。Cox回归分析显示，移植后第一年死亡的独立危险因素包括OLT术后AKI（风险比[HR] 12.1；P<0.05）、OLT术后感染（HR 4.7；P<0.01）、OLT前高血压（HR 4.4；P<0.01）以及OLT术后APACHE II≥10（HR 3.6；P<0.05）。我们得出结论，AKIN标准定义的AKI是OLT的主要并发症，与不良预后相关。积极的围手术期治疗预防AKI是否能改善OLT患者的生存率仍有待评估。
