Department of Anesthesiology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.
Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.
Nephrology (Carlton). 2020 Sep;25(9):700-707. doi: 10.1111/nep.13702. Epub 2020 Mar 12.
Acute kidney injury (AKI) is a serious complication following orthotopic liver transplantation (OLT) and it affects long-term patient survival. The aims of this study were to identify the effects of cumulative fluid balance (FB) on early post-OLT AKI and adverse outcomes and to construct a model to predict AKI.
We retrospectively analysed 146 adult patients who underwent OLT. AKI severity was classified according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Univariate and multivariate logistic regression analyses were used to evaluate the association between cumulative FB and post-OLT AKI. The Kaplan-Meier method was used to estimate the survival rate.
Within the perioperative period of 72 hours, 50% (66/132) of patients developed AKI, with 36 (54%), 16 (24%) and 14 (21%) patients having AKI stages 1, 2 and 3, respectively. The cumulative FB was the risk factors for post-OLT AKI (odds ratio [OR], 1.011; 95% confidence interval [CI], 1.1566.001; P = .021). Preoperative albumin was a protective factor for post-OLT AKI (OR, 0.309; 95% CI, 0.1400.731; P = .007). The AKI group requires renal replacement therapy (RRT) more (15.2% vs 0%, P = .001) and associated with postoperative complications (56% vs 28.8%, P = .003). The complication-free survival was lower in the AKI group ([11.90 vs 18.74] months, χ = 9.60, P = .002).
Cumulative FB within 72 hours is associated with post-OLT AKI and requires RRT. Cumulative FB impacts the long-term complication-free survival of the recipients.
急性肾损伤（AKI）是肝移植（OLT）后的严重并发症，影响患者的长期生存。本研究旨在确定累积液体平衡（FB）对 OLT 后早期 AKI 及不良预后的影响，并构建预测 AKI 的模型。
我们回顾性分析了 146 例接受 OLT 的成年患者。根据改善全球肾脏病预后组织（KDIGO）标准对 AKI 严重程度进行分类。采用单因素和多因素逻辑回归分析评估累积 FB 与 OLT 后 AKI 的关系。采用 Kaplan-Meier 法估计生存率。
在围手术期 72 小时内，50%（66/132）的患者发生 AKI，其中 36（54%）、16（24%）和 14（21%）例患者 AKI 分期分别为 1 期、2 期和 3 期。累积 FB 是 OLT 后 AKI 的危险因素（优势比[OR]，1.011；95%置信区间[CI]，1.1566.001；P =.021）。术前白蛋白是 OLT 后 AKI 的保护因素（OR，0.309；95%CI，0.1400.731；P =.007）。AKI 组需要肾脏替代治疗（RRT）更多（15.2% vs 0%，P =.001），并与术后并发症相关（56% vs 28.8%，P =.003）。AKI 组无并发症生存率较低（[11.90 比 18.74]个月，χ = 9.60，P =.002）。
72 小时内的累积 FB 与 OLT 后 AKI 及需要 RRT 相关。累积 FB 影响受者的长期无并发症生存。
