Clinical characteristics of early acute kidney injury following liver transplantation / 中华器官移植杂志

ABSTRACT

Objective To examine the clinical characteristics and risk factors for acute kidney injury (AKI) in patients receiving donation after cardiac death liver transplantation during the immediate postoperative period.Methods Patients who underwent liver transplantation between July 2013 and January 2017 were study retrospectively.AKI was defined according to the criteria of Kidney Disease Improving Global Outcomes (KDIGO) guideline in the first 7 days following liver transplantation.Donor and graft variables,and recipient characteristics in the perioperative period were analyzed to identify the risk factors for development of AKI.Results Thirty-five (67.3％) of the 52 included patients developed AKI 7 days post-liver transplantation,including 16 (30.8％) in stage 1,5 (9.6％) in stage-2 and 14 (26.9％) in stage-3 with KDIGO guideline criteria.85.7％ (30/35) of AKI occurred within postoperative day 0 to day 2,and the renal function of 60.0％ (21/35) patients who developed AKI recovered within 3 days.Patients with AKI had a prolonged ICU stay (for AKI,7.4±6.5 days;for non-AKI,4.0 ± 2.1 days,P =0.037) and an increased likelihood of 28-day mortality after transplantation (for AKI,17.1％;for non-AKI,0).Significant risk factors for development of AKI were detected including donors' ICU stay＞7 days,recipients' preoperative model for end-stage liver disease (MELD) score ＞12,preoperative serum urea nitrogen＞4.9 mmol/L,intraoperative blood loss＞ 5 000 mL,intraoperative total fluid infusion＞ 11 000 mE and peak postoperative glutamic-oxaloacetic transaminase (AST)＞ 1 240 U/L.Logistic regression analysis showed that recipients' preoperative MELD score ＞ 12 (odds ratio 25.3,P =0.027) and peak postoperative AST ＞ 1 240 U/L (odds ratio 37.1,P =0.012) were independent risk factors for development of AKI after liver transplantation.Conclusion Liver transplantation is associated with a high frequency of AKI.Increased recipients' preoperative MELD score and peak postoperative AST are independent risk factors for development of early AKI after liver transplantation.