Wyssusek K H, Keys A L B, Yung J, Moloney E T, Sivalingam P, Paul S K
Department of Anaesthesia, Princess Alexandra hospital and School of Medicine, University of Queensland, Brisbane, Queensland.
Department of Anaesthesia, Princess Alexandra Hospital, Brisbane, Queensland.
Anaesth Intensive Care. 2015 Nov;43(6):757-63. doi: 10.1177/0310057X1504300614.
Acute kidney injury (AKI) is a common complication following orthotopic liver transplantation. It is associated with increased morbidity and mortality, as well as increased healthcare costs. The aetiology of AKI post liver transplantation is multifactorial and understanding these factors is pivotal in developing risk stratification and prevention strategies. This study aims to investigate the preoperative and intraoperative factors that may be associated with AKI in patients undergoing liver transplantation at the Princess Alexandra Hospital, Brisbane, Queensland. In our study, retrospective data of 97 consecutive orthotopic liver transplantations performed between January 2009 and August 2012 were recorded. Univariate and multivariate analyses were performed to investigate the preoperative and intraoperative risk factors for the development of AKI in this cohort. In the cohort of 97 patients who underwent orthotopic liver transplantation, 24 patients (25%) developed postoperative AKI. Univariate analysis demonstrated that high preoperative body mass index and intraoperative noradrenaline use were both associated with AKI. Multivariate analysis demonstrated that high body mass index, high Model for End-stage Liver Disease score and intraoperative noradrenaline use were associated with AKI. Overall mortaility was 4.1% during the study period and was not significantly different between the two groups. The high incidence of AKI following liver transplantation in this study cohort highlights the importance of this issue. This study has identified several potential pre- and intraoperative risk factors, providing a focus for patient surveillance and future research.
急性肾损伤（AKI）是原位肝移植术后常见的并发症。它与发病率和死亡率的增加以及医疗成本的上升相关。肝移植术后AKI的病因是多因素的，了解这些因素对于制定风险分层和预防策略至关重要。本研究旨在调查昆士兰州布里斯班亚历山德拉公主医院接受肝移植患者中可能与AKI相关的术前和术中因素。在我们的研究中，记录了2009年1月至2012年8月期间连续进行的97例原位肝移植的回顾性数据。进行单因素和多因素分析以调查该队列中AKI发生的术前和术中危险因素。在97例行原位肝移植的患者队列中，24例（25%）发生了术后AKI。单因素分析表明，术前高体重指数和术中使用去甲肾上腺素均与AKI相关。多因素分析表明，高体重指数、高终末期肝病模型评分和术中使用去甲肾上腺素与AKI相关。研究期间总体死亡率为4.1%，两组之间无显著差异。本研究队列中肝移植术后AKI的高发病率凸显了这个问题的重要性。本研究确定了几个潜在的术前和术中危险因素，为患者监测和未来研究提供了重点。
