Risk factors of acute kidney injury in children with biliary atresia after liver transplantation / 国际外科学杂志

ABSTRACT

Objective:To analyze the incidence and risk factors of acute kidney injury in children with biliary atresia after liver transplantation.Methods:The retrospective case-control study was conducted.The clinical data of 115 children with biliary atresia who received liver transplantation for the first time in Beijing Friendship Hospital Affiliated to Capital Medical University from December 2018 to November 2020 were collected.The patients were divided into AKI group ( n=39) and non-AKI group ( n=76) according to the diagnostic criteria of the Kidney Disease Improving Global Outcomes(KDIGO). The differences of clinical indicators between the two groups were compared, and multivariate logistic regression analysis was performed for statistically significant variables ( P<0.05) to further determine the independent risk factors for AKI after liver transplantation. The measurement data of normal distribution were expressed as mean±standard deviation ( ± s), and t-test was used for comparison between groups.Measurement data with non-normal distribution were represented by M( Q1, Q3), and Mann-Whitney U test was used for comparison between groups.Count data were expressed as cases and percentage, and comparisons between groups were made using Chi-square test or Fisher′s exact test. Results:The incidence of AKI in biliary atresia patients after liver transplantation was 33.9%. Univariate analysis showed that there were statistically significant differences in age ( OR=0.721, 95% CI 0.553-0.938, P=0.014), preoperative infection ( OR=3.307, 95% CI 1.294-8.468, P=0.013), PELD score ( OR=1.065, 95% CI 1.031-1.101, P<0.001), serum creatinine numerical value ( OR=0.745, 95% CI 0.657-0.858, P<0.001), intraoperative red blood cell transfusion ( OR=1.034, 95% CI 1.028-1.051, P<0.001) and intraoperative plasma transfusion ( OR=1.055, 95% CI 1.025-1.086, P=0.002) between the AKI group and the non-AKI group ( P< 0.05). Multivariate logistic regression analysis was performed on the selected indicators by univariate analysis, and the results showed that preoperative infection ( OR=3.763, 95% CI 1.185-11.945, P=0.025) and low serum creatinine ( OR=0.685, 95% CI 0.570-0.823, P<0.001), intraoperative red blood cell transfusion ( OR=1.033, 95% CI 1.015-1.056, P=0.028) was independently associated with postoperative AKI ( P<0.05). The inpatient treatment time in ICU and in hospital between the two groups were statistically significant ( P<0.05). Conclusions:Preoperative infection, low creatinine numerical value and intraoperative red blood cell transfusion are independent risk factors for postoperative AKI in children with biliary atresia. AKI may prolong the time in ICU and in hospital.