Incidence,Risk Factors And Prognosis Of Acute Kidney Injury After Liver Transplantation

【Research background and purpose】Liver transplantation(LT)has become the first choice for patients with end-stage liver disease(ESLD).Acute kidney injury(AKI)is still one of the common life-threatening complications after liver transplantation.The mechanism of its occurrence is complex,and there is no effective means of prevention and treatment at present,so early prevention and diagnosis is particularly important.The purpose of this study is to determine the incidence,risk factors and prognosis of early acute kidney injury in liver transplantation patients with normal preoperative renal function,so as to provide early clinical intervention,improve the prognosis and reduce the long-term mortality.【Materials and methods】A retrospective case-control study was conducted among adult patients who underwent liver transplantation in organ transplantation center of Affiliated Hospital of Qingdao University from January 1,2018 to December 31,2018.According to the inclusion and exclusion criteria,110 patients were included.Aki was diagnosed according to the criteria of improving global outcomes(KDIGO).AKI was divided into two groups: acute kidney injury group and non acute kidney injury group,Objective to investigate the incidence,risk factors and prognosis of AKI after liver transplantation.【Results】Among 110 patients,91 were male and 19 were female.The average age was 52.6years ± 6 years old.57 cases(51.8%)developed acute kidney injury within 7 days after operation,including 27 cases(47.4%)in aki-1 stage,12 cases(21.1%)in aki-2stage and 18 cases(31.6%)in aki-3 stage.Aki-1-2 stage accounted for 68.4% of all patients with acute kidney injury after operation.Univariate analysis showed that there were 7 factors influencing the occurrence of postoperative acute kidney injury:body mass index(BMI),history of gastrointestinal hemorrhage,total bilirubin,preoperative serum cystatin C level,graft receptor weight ratio,anhepatic period,anhepatic urine volume(P < 0.05).Multivariate analysis showed that body mass index(or = 1.18,95% CI 1.00-1.40,P = 0.048)and preoperative cystatin C level(or =7.65,95% CI 1.25-46.87,P = 0.028)were independent risk factors for AKI after liver transplantation.Urine volume in anhepatic phase(or = 0.99,95% CI = 0.98-0.99,P =0.028)was an independent protective factor for postoperative acute kidney injury.Compared with the non AKI group,the patients in the acute kidney injury group after liver transplantation have the characteristics of long postoperative ventilation time,high proportion of early postoperative death,and longer hospital stay.【Conclusion】In patients with normal preoperative renal function,acute kidney injury is still one of the most common complications after liver transplantation.Body mass index,history of gastrointestinal hemorrhage,total bilirubin,preoperative serum cystatin C level,graft recipient weight ratio,anhepatic period and anhepatic urine volume were the important risk factors for the occurrence of body mass index,High BMI,high preoperative serum cystatin C level and decreased anhepatic urine volume were independent risk factors for AKI after liver transplantation.For these high-risk factors patients need to focus on,so that patients get better prognosis.Aki patients after liver transplantation have many early postoperative complications,long hospitalization time,poor prognosis and high hospitalization cost.Therefore,it is necessary to identify the influencing factors,carry out early prevention and active prevention strategies,so as to avoid the occurrence of AKI and improve the prognosis of LT patients.