Department of Transplantation, The Third Xiangya Hospital, Central South University, Changsha, China.
Engineering and Technology Research Center for Transplantation Medicine of National Health Comission, The Third Xiangya Hospital, Central South University, Changsha, China.
Sci Rep. 2023 Mar 27;13(1):4978. doi: 10.1038/s41598-023-31757-8.
Acute kidney injury (AKI) remains to be a common but severe complication after liver transplantation (LT). However, there are still few clinically validated biomarkers. A total of 214 patients who underwent routine furosemide (1-2 mg/kg) after LT were retrospectively included. The urine output during the first 6 h was recorded to evaluate the predictive value of AKI stage 3 and renal replacement therapy (RRT). 105 (49.07%) patients developed AKI, including 21 (9.81%) progression to AKI stage 3 and 10 (4.67%) requiring RRT. The urine output decreased with the increasing severity of AKI. The urine output of AKI stage 3 did not significantly increase after the use of furosemide. The area under the receiver operator characteristic (ROC) curves for the total urine output in the first hour to predict progression to AKI stage 3 was 0.94 (p < 0.001). The ideal cutoff for predicting AKI progression during the first hour was a urine volume of less than 200 ml with a sensitivity of 90.48% and specificity of 86.53%. The area under the ROC curves for the total urine output in the six hours to predict progression to RRT was 0.944 (p < 0.001). The ideal cutoff was a urine volume of less than 500 ml with a sensitivity of 90% and specificity of 90.91%. Severe AKI after liver transplantation seriously affects the outcome of patients. Lack of furosemide responsiveness quickly and accurately predict AKI stage 3, and patients requiring RRT after the operation.
急性肾损伤（AKI）仍然是肝移植（LT）后常见但严重的并发症。然而，目前仍然缺乏临床验证的生物标志物。回顾性纳入了 214 例 LT 后常规使用呋塞米（1-2mg/kg）的患者。记录术后 6 小时内的尿量，以评估 AKI 3 期和肾脏替代治疗（RRT）的预测价值。105 例（49.07%）患者发生 AKI，其中 21 例（9.81%）进展为 AKI 3 期，10 例（4.67%）需要 RRT。随着 AKI 严重程度的增加，尿量减少。AKI 3 期患者使用呋塞米后尿量无明显增加。第一个小时总尿量预测 AKI 3 期进展的受试者工作特征（ROC）曲线下面积为 0.94（p<0.001）。第一个小时预测 AKI 进展的理想截点为尿量少于 200ml，灵敏度为 90.48%，特异性为 86.53%。6 小时总尿量预测 RRT 进展的 ROC 曲线下面积为 0.944（p<0.001）。理想截点为尿量少于 500ml，灵敏度为 90%，特异性为 90.91%。肝移植后严重 AKI 严重影响患者的预后。缺乏呋塞米反应性可快速、准确地预测 AKI 3 期和术后需要 RRT 的患者。
