Kundakci A, Pirat A, Komurcu O, Torgay A, Karakayalı H, Arslan G, Haberal M
Department of Anesthesiology, Baskent University Faculty of Medicine, Ankara, Turkey.
Transplant Proc. 2010 Dec;42(10):4171-4. doi: 10.1016/j.transproceed.2010.09.137.
RIFLE criteria have been used to determine the incidence of acute kidney dysfunction (AKD) after orthotopic liver transplantation (OLT). However, no studies have focused on the incidence of AKD after OLT in patients with normal pre-OLT kidney functions. Using the RIFLE criteria, we determined the incidence and risk factors for AKD after OLT in patients with normal pre-OLT kidney function. We retrospectively analyzed the records of 112 patients who underwent OLT from January 2000 to February 2009 with normal prior kidney function. We investigated three levels of renal dysfunction outlined in the RIFLE criteria: risk (R); injury (I); and failure (F). Preoperative, intraoperative, and postoperative variables were collected. AKD occurred in 64 (57%) OLTs with risk, injury, and failure frequencies of 19%, 11%, and 28%, respectively. Compared with those who did not develop AKD postoperatively, those who did had significantly higher MELD scores (19 ± 7 vs 16 ± 8; P = .018), more frequently use of inotropic agents intraoperatively (54% vs 35%; P = .070), more colloid treatment (300 ± 433 mL vs 105 ± 203 mL; P = .007), longer anhepatic phase (88.0 ± 42.0 minutes vs 73.0 ± 20.0 minutes; P = .037), and a greater incidence of intraoperative acidosis (64% vs 44%; P = .047). Logistic regression analysis revealed that MELD score (odds ratio 1.107, 95% CI 1.022-1.200, P = .013), duration of anhepatic phase (odds ratio 1.020 95% CI 1.000-1.040, P = .053), and intraoperative acidosis (odds ratio 0.277 95% CI 0.093-0.825 P = .021) were independent risk factors for AKD. In conclusion, our results suggested that, based on RIFLE criteria, AKD occurs in more than half of OLTs postoperatively. A higher MELD score, longer anhepatic phase, and occurrence of intraoperative acidosis were associated with AKD.
RIFLE标准已被用于确定原位肝移植（OLT）后急性肾功能障碍（AKD）的发生率。然而，尚无研究聚焦于OLT前肾功能正常的患者术后AKD的发生率。我们采用RIFLE标准，确定了OLT前肾功能正常的患者术后AKD的发生率及危险因素。我们回顾性分析了2000年1月至2009年2月期间112例行OLT且术前肾功能正常患者的记录。我们调查了RIFLE标准中定义的三个肾功能障碍水平：风险（R）；损伤（I）；衰竭（F）。收集了术前、术中和术后的变量。64例（57%）OLT发生了AKD，风险、损伤和衰竭的发生率分别为19%、11%和28%。与术后未发生AKD的患者相比，发生AKD的患者终末期肝病模型（MELD）评分显著更高（19±7 vs 16±8；P = 0.018），术中更频繁使用血管活性药物（54% vs 35%；P = 0.070），胶体治疗更多（300±433 mL vs 105±203 mL；P = 0.007），无肝期更长（88.0±42.0分钟 vs 73.0±20.0分钟；P = 0.037），术中酸中毒发生率更高（64% vs 44%；P = 0.047）。逻辑回归分析显示，MELD评分（比值比1.107，95%可信区间1.022 - 1.200，P = 0.013）、无肝期时长（比值比1.020，95%可信区间1.000 - 1.040；P = 0.053）和术中酸中毒（比值比0.277，95%可信区间0.093 - 0.825，P = 0.021）是AKD的独立危险因素。总之，我们的结果表明，基于RIFLE标准，超过半数的OLT术后会发生AKD。较高的MELD评分、较长的无肝期和术中酸中毒的发生与AKD相关。
