Sirivatanauksorn Y, Parakonthun T, Premasathian N, Limsrichamrern S, Mahawithitwong P, Kositamongkol P, Tovikkai C, Asavakarn S
Hepatopancreatobiliary and Transplant Surgery Unit, Division of General Surgery, Department of Surgery, Siriraj Organ Transplantation Center, Siriraj Hospital, Bangkok, Thailand.
Hepatopancreatobiliary and Transplant Surgery Unit, Division of General Surgery, Department of Surgery, Siriraj Organ Transplantation Center, Siriraj Hospital, Bangkok, Thailand.
Transplant Proc. 2014 Apr;46(3):818-21. doi: 10.1016/j.transproceed.2013.11.124.
Identification of risk factors of acute renal failure (ARF) after orthotopic liver transplantation (OLT) may avoid the development and attenuate the impact on patient outcome. Therefore, the incidence and risk factors of ARF after OLT at Siriraj Hospital were analyzed.
The study was retrospectively analyzed from the OLT patients at the Siriraj Hospital between January 2002 and December 2009. ARF was defined as an increased in serum creatinine level more than 1.5 times within the first week postoperation compared with the preoperative level.
A total of 81 liver transplant patients were analyzed. The mean age was 52.45 years (range, 22 to 71) and there were 25 women (30.86%) and 56 men (69.14%). Indications for OLT were end-stage liver cirrhosis (n = 43, 53.09%), hepatocellular carcinoma (n = 36, 44.44%), and fulminant hepatic failure (n = 2, 2.47%). Fifty-eight patients (71.60%) developed ARF, and the perioperative mortality of these was 18.97%. The univariate analysis identified the presence of preoperative coagulopathy, prolonged intraoperative hypotension, more blood loss, and postoperative hypotension as the risk factors of ARF. By the multivariate analysis, prolonged intraoperative hypotension more than 30 minutes and presence of postoperative hypotension were the independent risk factors of ARF. During the intraoperative and postoperative periods, ARF group required more blood and blood components transfusion, longer intensive care unit stay, and higher in-hospital mortality. Seven patients (12.07%) in the ARF group required postoperative renal replacement therapy. Four patients (9.52%) developed chronic renal failure, and one of them required long-term hemodialysis.
ARF was a common complication after OLT, which caused increased morbidity and mortality. Although some patients required dialysis, most of them recovered normal renal function. Prolonged intraoperative hypotension and presence of postoperative hypotension were the independent risk factors of ARF after OLT.
识别原位肝移植（OLT）后急性肾衰竭（ARF）的危险因素可避免其发生，并减轻对患者预后的影响。因此，对诗里拉吉医院OLT术后ARF的发病率及危险因素进行了分析。
对2002年1月至2009年12月在诗里拉吉医院接受OLT的患者进行回顾性分析。ARF定义为术后第一周内血清肌酐水平较术前升高超过1.5倍。
共分析了81例肝移植患者。平均年龄为52.45岁（范围22至71岁），其中女性25例（30.86%），男性56例（69.14%）。OLT的适应证为终末期肝硬化（n = 43，53.09%）、肝细胞癌（n = 36，44.44%）和暴发性肝衰竭（n = 2，2.47%）。58例患者（71.60%）发生ARF，其围手术期死亡率为18.97%。单因素分析确定术前凝血功能障碍、术中长时间低血压、失血较多和术后低血压为ARF的危险因素。多因素分析显示，术中长时间低血压超过30分钟和术后低血压是ARF的独立危险因素。在术中和术后期间，ARF组需要更多的血液和血液成分输血、更长的重症监护病房住院时间和更高的院内死亡率。ARF组中有7例患者（12.07%）需要术后肾脏替代治疗。4例患者（9.52%）发生慢性肾衰竭，其中1例需要长期血液透析。
ARF是OLT术后常见的并发症，可导致发病率和死亡率增加。虽然部分患者需要透析，但大多数患者肾功能恢复正常。术中长时间低血压和术后低血压是OLT术后ARF的独立危险因素。
