肝移植术后早期急性肾损伤的危险因素分析  

Risk factors for early acute kidney injury after classic orthotopic liver transplantation

作　　者：陈佳弘 徐莹 何松哲 李涛 白云昊 宋相钦 赵甜甜 李威[2] 蒋鸿涛 王毅[1] Chen Jiahong;Xu Ying;He Songzhe;Li Tao;Bai Yunhao;Song Xiangqin;Zhao Tiantian;Li Wei;Jiang Hongtao;Wang Yi(Department of Kidney Transplantation,Second Affiliated Hospital of Hainan Medical College,Haikou 570311,China;Department of Liver Transplantation,Second Affiliated Hospital of Hainan Medical College,Haikou 570311,China)

机构地区：[1]海南医学院第二附属医院肾移植科,海口570311 [2]海南医学院第二附属医院肝移植科,海口570311

出　　处：《中华器官移植杂志》2023年第5期269-274,共6页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金(82260154);海南省临床医学中心建设项目。

摘　　要：目的分析影响肝移植术后急性肾损伤(acute kidney injury, AKI)发生的危险因素。方法回顾性分析2019年11月至2022年11月于海南医学院第二附属医院进行经典原位肝移植手术的105例受者的临床资料, 其中男性89例, 女性16例, 年龄(50.52±10.35)岁。根据改善全球肾脏病预后组织(KDIGO)在2012年修订的AKI诊断与分期标准, 将105例受者分为AKI组(66例)和非AKI组(39例)。分析比较两组受者的一般资料和既往病史、终末期肝病模型(MELD)评分、总胆红素、白蛋白、血清肌酐水平、凝血功能等临床资料, 将差异有统计学意义的因素纳入多因素logistic回归分析, 得出肝移植术后早期急性肾损伤的独立危险因素。结果在105例接受经典原位肝移植的受者中, 有66例在术后7 d内发生了AKI, 发生率为62.86%, 其中AKI 1期46例, 占69.70%, AKI 2期10例, 占15.15%, AKI 3期10例, 占15.15%。差异性分析结果提示AKI组和非AKI组的年龄、腹部手术史、术前血清肌酐水平、手术时间、无肝期时间、术中输血浆量差异有统计学意义(均P<0.05)。多因素logistic回归分析表明腹部手术史(OR=5.803, 95%CI:1.008~33.401, P=0.049)、无肝期时间(OR=1.054, 95%CI:1.008~1.101, P=0.020)和术前血清肌酐水平(OR=0.968, 95%CI:0.943~0.994, P=0.016)为肝移植受者术后早期发生AKI的独立危险因素。结论腹部手术史、无肝期时间、术前血清肌酐水平是肝移植受者术后早期发生AKI的独立危险因素。Objective To explore the risk factors affecting the incidence of acute kidney injury(AKI)after liver transplantation(LT).Methods From November 2019 to November 2022,clinical data were retrospectively reviewed for 105 recipients of classic orthotopic LT.There are 89 males and 16 females with an age range of(50.52±10.35)years.They are assigned into two groups of AKI(66 cases)and non-AKI(39 cases)according to the AKI diagnostic and staging criteria of Global Kidney Disease Prognosis Organization in 2012.General profiles and clinical data(e.g.previous medical history,MELD score,total bilirubin,albumin,serum creatinine level,coagulation function,anhepatic phase and time to surgery)of two groups of recipients are compared.The factors with statistically significant differences are included into multivariate Logistic regression analysis for obtaining independent risk factors for early AKI post-LT.Results Among them,66 patients developed AKI within 7 days post-operation with an incidence rate of 62.86%(66/105).The clinical stages of AKI areⅠ(46 cases,69.70%),Ⅱ(10 cases,15.15%)andⅢ(10 cases,15.15%).Statistically significant inter-group differences exists in age,abdominal surgery history,preoperative serum level of creatinine,operative duration,anhepatic phase and intraoperative plasma transfusion(all P<0.05).Multivariate Logistic regression analysis indicated that abdominal surgery history(OR=5.803,95%CI:1.008~33.401,P=0.049),anhepatic phase(OR=1.054,95%CI:1.008~1.101,P=0.020)and preoperative serum level of creatinine(OR=0.968,95%CI:0.943~0.994,P=0.016)are independent risk factors for early AKI after classical orthotopic LT recipients.Conclusions Abdominal surgery history,anhepatic phase,and preoperative serum level of creatinine are independent risk factors for early AKI in classic orthotopic LT recipients.

关 键 词：肝移植 急性肾损伤 危险因素 无肝期 

分 类 号：R657.3[医药卫生—外科学] R692[医药卫生—临床医学]