Epidemiological Research Of Acute Kidney Injury After Orthotopic Liver Transplantation

Background Acute kidney injury (AKI) is a major complication following orthotopic liver transplantation and is associated with increased postoperative morbidity and mortality. There has been no research in summarizing this issue in Chinese people. The aim of the present study was to analysis the risk factors of AKI in liver transplantation patient to investigate the possibility of prophylaxis and treatment and assess the value of for end-stage liver disease in predicting the outcome of AKI after liver transplantation.Methods Data from 809 patients who underwent liver transplantation from January 2001 to October 2011 were analyzed. Demographic characteristics, pre- and intraoperative general conditions, preoperative complications, Child-Pugh classification, MELD score, operation time, cold/hot ischemia time for liver, time without hepatic, vein bypass time, intraoperative urine output, intraoperative hypotension (<90/60mmHg) duration, perioperative blood vessels active drug consumption, intraoperative blood product usage, in and out of the infusion, blood transfusions, lead flow, situation of RRT and the clinical outcome were recorded.Results Of the 809 cases of liver transplantation, the overall incidence of AKI was 22.2%(n=180), RIFLE-113.0%(n=105), RIFLE-24.2%(n=34), RIFLE-35.1% (n=41). The incidence of AKI requiring renal replacement treatment (AKI-RRT) was 2.6%(n=21). The overall 30 days mortality was 5.6%, and was significantly higher in AKI group than in non-AKI group (11.1% vs.4.1%, P<0.001). The 30 days mortality of AKI-RRT group was 9.5%. Multivariate logistic regression analysis showed that age>55y, CHILD C, intraoperatve blood loss >5000ml and FK506 concentration>15mg/L were risk factors of AKI after liver transplantation. ARDS was the main risk factors of postoperative RRT. Duration of low systolic blood pressure (SBP<90mmHg) in operation>1h and liquid access quantity difference in first postoperative day>3000ml were 30 days death independent risk factors of OLT patients with AKI. Age>55y, ABO-incompatible graft, volume of ascites>2000ml, postoperative eGFR<30 ml/min/1.73m2 and TBil>5mg/dl were 12 months of death independent risk factors of OLT patients with AKI.The time of anthepatic>90min, duration of low systolic blood pressure (SBP<90mmHg) in operation>lh, postoperative BUN>18mmol/L、postoperative SCr>1.2mg/dl, postoperative eGFR<30 ml/min/1.73m2 and postoperative second day liquid access quantity difference>1500ml were independent risk factors for the AKI patients whose renal function have recovered in 30 days after OLT. The independent risk factors for the AKI patients recover renal function in 12 months after operation including ABO-incompatible graft, volume of ascites>2000ml, postoperative BUN>18mmol/L postoperative SCr>1.2mg/dl, postoperative eGFR<30 ml/min/1.73m, the first day urine volum after OLT<1500ml and postoperative second day liquid access quantity difference>500ml.Conclusions 1) AKI incidence along with 30 days mortality rate after liver transplantation was significantly higher than in non-AKI group.2) AKI complicating acute lung injury after liver transplantation, especially in patients with ARDS should start early renal replacement therapy.3) Duration of low systolic blood pressure in operation were 30 days of death and renal recovery independent risk factors of OLT patients with AKI.4) ABO-incompatible graft,volume of ascites and postoperative eGFR was not a independent risk factors of 12 months death for AKI patients, but renal recovery after 12 months.