Li Desheng, Guan Qinghua, Chen Chuanlin, Sheng Bo, Zhang Zhenyu, Hu Yongfang
School of Clinical Medicine, Qinghai University, Xining, People's Republic of China.
Liver ICU, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People's Republic of China.
J Pharm Policy Pract. 2024 Dec 20;18(1):2438225. doi: 10.1080/20523211.2024.2438225. eCollection 2025.
Fluid administration is a critical component of perioperative management for liver transplant recipients, and excessive fluid infusion can lead to acute kidney injury (AKI) and poor patient outcomes.
We conducted a cross-sectional survey on the fluid intake and output of adult liver transplant recipients over a 7-day period. The patients were divided into AKI and non-AKI groups. Multivariate logistic regression analyses were used to evaluate the association between fluid balance (FB) and AKI. A Kaplan-Meier survival analysis was performed to determine the survival of the recipient survival at 180 days.
A total of 210 liver transplant recipients were included. The peak FB occurred on the second day after transplantation, which was higher than on the seventh day (0.3 [, -0.2 to 0.8] L vs. -0.4 [, -1.0 to 0.3] L, < 0.001). The highest incidence of AKI was observed on the second day after transplantation and the lowest on the seventh day (52.4% vs. 15.4%, < 0.001). Multivariate analysis showed that a cumulative FB > 1 L within the first 2 days postoperatively was an independent risk factor for AKI on the second day after liver transplantation (LT) ( = 2.66, % , 1.31-5.41, = 0.007). Survival analysis indicated significant differences in 180-day survival rates among patients with different grades of AKI [94.0% (grade 1) vs. 91.4% (grade 2) vs. 77.8% (grade 3), = 12.93, < 0.001].
There is a significant correlation between post-LT AKI and perioperative FB. Cumulative FB > 1 L in the first 2 days postoperatively is an independent risk factor for AKI on the second day after LT. AKI after LT is associated with a lower 180-day survival rate in patients.
液体管理是肝移植受者围手术期管理的关键组成部分，过量输液可导致急性肾损伤（AKI）并影响患者预后。
我们对成年肝移植受者7天内的液体出入量进行了横断面调查。将患者分为AKI组和非AKI组。采用多因素逻辑回归分析评估液体平衡（FB）与AKI之间的关联。进行Kaplan-Meier生存分析以确定受者180天时的生存率。
共纳入210例肝移植受者。FB峰值出现在移植后第二天，高于第七天（0.3[, -0.2至0.8]L对-0.4[, -1.0至0.3]L，<0.001）。AKI发生率在移植后第二天最高，第七天最低（52.4%对15.4%，<0.001）。多因素分析显示，术后前两天累积FB>1L是肝移植（LT）后第二天发生AKI的独立危险因素（=2.66，%，1.31 - 5.41，=0.007）。生存分析表明，不同等级AKI患者的180天生存率存在显著差异[94.0%（1级）对91.4%（2级）对77.8%（3级），=12.93，<0.001]。
LT后AKI与围手术期FB之间存在显著相关性。术后前两天累积FB>1L是LT后第二天发生AKI的独立危险因素。LT后AKI与患者较低的180天生存率相关。
