Ali Ahmed Y, William Kerolis Y, Emad Nahla, Mogawer Mohamed S, Elshazli Mostafa M, Youssof Maha, Zidan Mahmoud
Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt.
Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt.
Transplant Proc. 2019 Sep;51(7):2425-2429. doi: 10.1016/j.transproceed.2019.03.045. Epub 2019 Jul 2.
Acute kidney injury (AKI) is common in patients undergoing liver transplantation and is associated with reduced patient and graft survival. The aim is to assess the occurrence of AKI following living donor liver transplantation and to evaluate the associated risk factors and outcomes.
Forty-nine Egyptian patients with hepatitis C virus who underwent living donor liver transplantation were divided into Group A (17 patients with AKI defined as increased creatinine > 50% of the initial pretransplant level) and Group B (non-AKI patients). Fluid balance, kidney function, preoperative and intraoperative risk factors, outcomes, and 1-year mortality were assessed.
The mean age was 48 ± 7.51 and the majority of patients assessed were men (89.8%). The 17 patients with AKI had higher preoperative creatinine and higher Model for End-Stage Liver Disease scores (1.3 ± 0.16, 15.7 ± 5.07, respectively) than the non-AKI patients (1.1 ± .15, 13.7 ± 4.61, respectively), with P values of .04 and < .01, respectively. They also had significantly lower levels of albumin (2.98 ± .50). AKI patients had longer intensive care unit (ICU) stays (10 ± 3 d) compared to non-AKI patients (5 ± 2), with a P value of .03. A logistic multivariable regression test revealed that only a long ICU stay is a predictor of developing acute kidney injury among patients who have undergone living donor liver transplantation (odds ratio 1.23, 95% confidence interval 1.1-2.1, with a P value of .012).
Many pre- and intra-operative factors are associated with AKI development; however, a long ICU stay is an independent potential factor for kidney infection.
急性肾损伤（AKI）在肝移植患者中很常见，并且与患者生存率及移植物存活率降低相关。目的是评估活体肝移植后AKI的发生率，并评估相关危险因素及预后情况。
49例接受活体肝移植的埃及丙型肝炎病毒患者被分为A组（17例AKI患者，定义为肌酐升高超过移植前初始水平的50%）和B组（非AKI患者）。评估了液体平衡、肾功能、术前及术中危险因素、预后情况及1年死亡率。
平均年龄为48±7.51岁，大多数接受评估的患者为男性（89.8%）。17例AKI患者术前肌酐水平及终末期肝病模型评分（分别为1.3±0.16、15.7±5.07）高于非AKI患者（分别为1.1±0.15、13.7±4.61），P值分别为0.04和<0.01。他们的白蛋白水平也显著更低（2.98±0.50）。与非AKI患者（5±2天）相比，AKI患者在重症监护病房（ICU）的住院时间更长（10±3天），P值为0.03。多因素逻辑回归分析显示，在接受活体肝移植的患者中，只有长时间的ICU住院是发生急性肾损伤的预测因素（比值比1.23，95%置信区间1.1 - 2.1，P值为0.012）。
许多术前及术中因素与AKI的发生相关；然而，长时间的ICU住院是发生肾感染的一个独立潜在因素。
