Chae Min Suk, Lee Nuri, Park Da Hye, Lee Jisoo, Jung Hyun Sik, Park Chul Soo, Lee Jaemin, Choi Jong Ho, Hong Sang Hyun
Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Medicine (Baltimore). 2017 Aug;96(31):e7626. doi: 10.1097/MD.0000000000007626.
Acute kidney injury (AKI) is a common complication after living donor liver transplantation (LDLT). In this study, we investigated perioperative factors, including oxygen content, related to the postoperative development of AKI after LDLT. The perioperative data of 334 patients were reviewed retrospectively. We identified the postoperative development of AKI based on the Acute Kidney Injury Network criteria. Perioperative variables, including oxygen content, were compared between patients with and without AKI. Potentially significant variables in a univariate analysis were evaluated by multivariate analysis. Postoperative AKI developed in 76 patients (22.7%). Univariate analysis revealed that preoperative factors (body mass index [BMI], diabetes mellitus, C-reactive protein) and intraoperative factors (severe postreperfusion syndrome, packed red blood cell transfusion, furosemide, and oxygen content at the anhepatic phase, 5 minutes and 1 hour after graft reperfusion, and at peritoneal closure) of recipients were significant. The multivariate analysis showed that oxygen content 5 minutes after graft reperfusion, BMI, and furosemide administration were independently associated with postoperative AKI. In conclusion, postoperative AKI was independently associated with oxygen content 5 minutes after graft reperfusion, BMI, and furosemide administration. Meticulous ventilator care and transfusion should be required to maintain sufficient oxygen content immediately after graft reperfusion in patients who undergo LDLT.
急性肾损伤（AKI）是活体肝移植（LDLT）术后常见的并发症。在本研究中，我们调查了围手术期因素，包括氧含量，其与LDLT术后AKI的发生相关。回顾性分析了334例患者的围手术期数据。我们根据急性肾损伤网络标准确定了术后AKI的发生情况。比较了发生和未发生AKI患者的围手术期变量，包括氧含量。单因素分析中具有潜在显著意义的变量通过多因素分析进行评估。76例患者（22.7%）发生了术后AKI。单因素分析显示，受者的术前因素（体重指数[BMI]、糖尿病、C反应蛋白）和术中因素（严重再灌注综合征、浓缩红细胞输注、呋塞米，以及无肝期、移植肝再灌注后5分钟和1小时以及关腹时的氧含量）具有显著意义。多因素分析表明，移植肝再灌注后5分钟的氧含量、BMI和呋塞米的使用与术后AKI独立相关。总之，术后AKI与移植肝再灌注后5分钟的氧含量、BMI和呋塞米的使用独立相关。对于接受LDLT的患者，应进行细致的呼吸机护理和输血，以在移植肝再灌注后立即维持充足的氧含量。
