Chen Xiaohong, Ding Xiaoqiang, Shen Bo, Teng Jie, Zou Jianzhou, Wang Ting, Zhou Jian, Chen Nan, Zhang Boheng
Blood Purification Center, Zhongshan Hospital of Fudan University, Shanghai, 200032, People's Republic of China.
Department of Nephrology, Zhongshan Hospital of Fudan University, Shanghai, 200032, People's Republic of China.
J Cancer Res Clin Oncol. 2017 Jul;143(7):1337-1346. doi: 10.1007/s00432-017-2376-8. Epub 2017 Mar 13.
To describe the incidence and outcomes linked with acute kidney injury (AKI) after liver transplantation (LT) in hepatocellular carcinoma (HCC) patients.
From January 2003 to February 2011, HCC patients undergoing LT were retrospectively enrolled. Patient with a glomerular filtration rate (GFR) <60 mL/min/1.73 m was excluded. AKI was defined and classified according to the AKIN criteria.
Of the 566 eligible patients, AKI was found in 109 (19.26%) patients (stage I, 66 cases; stage II, 15 cases; and stage III, 28 cases). Risk factors for AKI were the long anhepatic time (OR = 3.59, P = 0.009) and prolonged duration of systolic blood pressure (SBP) < 90 mmHg (OR = 1.07, P < 0.0001). Post-LT AKI was an independent risk factor associated with 30-day mortality (HR = 4.05, P = 0.047). Complete recovery occurred in 84 (77.06%) of all AKI episodes within 1 month after operation, while 25 patients (22.94%) suffered from prolonged AKI. Patients with prolonged AKI had a poorer 1-year survival than those with transient AKI (40 vs 86.90%; P < 0.0001). Patients with severe AKI more often developed prolonged AKI. 13 patients (52%) of the prolonged AKI progressed to chronic kidney disease (CKD) defined as eGFR <60 mL/min/1.73 m after 1 year post-operation.
Post-LT AKI is not an uncommon complication. Intra-operative hemodynamic instability is crucial in the development of post-LT AKI and deserves more attention. Most post-LT AKI is transient and reversible, while the prolonged form may predict a decrease survival.
描述肝细胞癌（HCC）患者肝移植（LT）后急性肾损伤（AKI）的发生率及相关结局。
回顾性纳入2003年1月至2011年2月期间接受LT的HCC患者。排除肾小球滤过率（GFR）<60 mL/min/1.73 m²的患者。根据AKIN标准定义并分类AKI。
在566例符合条件的患者中，109例（19.26%）发生AKI（Ⅰ期66例；Ⅱ期15例；Ⅲ期28例）。AKI的危险因素为无肝期长（OR = 3.59，P = 0.009）和收缩压（SBP）<90 mmHg持续时间延长（OR = 1.07，P < 0.0001）。LT后AKI是30天死亡率的独立危险因素（HR = 4.05，P = 0.047）。84例（77.06%）AKI发作在术后1个月内完全恢复，而25例患者（22.94%）发生持续性AKI。持续性AKI患者的1年生存率低于短暂性AKI患者（40%对86.90%；P < 0.0001）。严重AKI患者更常发生持续性AKI。13例（52%）持续性AKI患者在术后1年进展为慢性肾脏病（CKD），定义为估算肾小球滤过率（eGFR）<60 mL/min/1.73 m²。
LT后AKI是一种常见并发症。术中血流动力学不稳定在LT后AKI的发生中起关键作用，值得更多关注。大多数LT后AKI是短暂且可逆的，而持续性AKI可能预示生存率降低。
