Sahinturk Helin, Ozdemirkan Aycan, Zeyneloglu Pinar, Gedik Ender, Pirat Arash, Haberal Mehmet
From the Anesthesiology and ICM Department, Baskent University Faculty of Medicine, Ankara, Turkey.
Exp Clin Transplant. 2021 Jul;19(7):659-663. doi: 10.6002/ect.2018.0214. Epub 2019 Mar 14.
Acute kidney injury after pediatric liver transplant is associated with increased morbidity and mortality. Here, we evaluated children with acute kidney injury early posttransplant using KDIGO criteria to determine incidence, risk factors, and clinical outcomes.
In this retrospective cohort study, medical records of all patients < 16 years old who underwent liver transplant from April 2007 to April 2017 were reviewed.
Of 117 study patients, 69 (59%) were male and median age at transplant was 72 months (range, 12-120 mo). Forty children (34.2%) had postoperative acute kidney injury, with most having stage 1 disease (n = 21). Compared with children who had acute kidney injury versus those who did not, preoperative activated partial thromboplastin time (median 35.6 s [interquartile range, 32.4-42.8 s] vs 42.5 s [interquartile range, 35-49 s]; P = .007), intraoperative lactate levels at end of surgery (median 5.3 mmol/L [interquartile range, 3.3-8.6 mmol/L] vs 7.9 mmol/L [interquartile range, 4.3-11.2 mmol/L]; P = .044), and need for open abdomen (3% vs 15%; P= .024) were significantly higher. Logistic regression analysis revealed that preoperative high activated partial thromboplastin time (P= .02), intraoperative lactate levels at end of surgery (P = .02), and need for open abdomen (P = .03) were independent risk factors for acute kidney injury. Children who developed acute kidney injury had significantly longer intensive care unit stay (7.1 ± 8.5 vs 4.4 ± 5.4 days, P= .04) and mortality (12.8% vs 1.8%; P = .01).
Early postoperative acute kidney injury occurred in 34.2% of pediatric liver transplant recipients, with patients having increased mortality risk. High preoperative activated partial throm-boplastin time, high intraoperative end of surgery lactate levels, and need for open abdomen were shown to be associated with acute kidney injury after pediatric liver transplant.
小儿肝移植术后急性肾损伤与发病率和死亡率增加相关。在此，我们使用KDIGO标准评估肝移植术后早期发生急性肾损伤的儿童，以确定发病率、危险因素和临床结局。
在这项回顾性队列研究中，我们回顾了2007年4月至2017年4月期间所有接受肝移植的16岁以下患者的病历。
117名研究患者中，69名（59%）为男性，移植时的中位年龄为72个月（范围12 - 120个月）。40名儿童（34.2%）术后发生急性肾损伤，大多数为1期疾病（n = 21）。与未发生急性肾损伤的儿童相比，发生急性肾损伤的儿童术前活化部分凝血活酶时间（中位值35.6秒[四分位间距，32.4 - 42.8秒]对42.5秒[四分位间距，35 - 49秒]；P = 0.007）、手术结束时术中乳酸水平（中位值5.3 mmol/L[四分位间距，3.3 - 8.6 mmol/L]对]7.9 mmol/L[四分位间距，4.3 - 11.2 mmol/L]；P = 0.044）以及开腹需求（3%对15%；P = 0.024）显著更高。逻辑回归分析显示，术前活化部分凝血活酶时间延长（P = 0.02）、手术结束时术中乳酸水平升高（P = 0.02）以及开腹需求（P = 0.03）是急性肾损伤的独立危险因素。发生急性肾损伤的儿童重症监护病房住院时间显著更长（7.1±8.5天对4.4±5.4天，P = 0.04）且死亡率更高（12.8%对1.8%；P = 0.0）。
34.2%的小儿肝移植受者术后早期发生急性肾损伤，患者死亡风险增加。术前活化部分凝血活酶时间延长、手术结束时术中乳酸水平升高以及开腹需求与小儿肝移植术后急性肾损伤相关。
