Clinical Research Of Indicators Which Affect Renal Function Impairment Incidence Rate Of Patients Undergoing Liver Transplatation

Objectives The purpose of this research is to discuss the factors which affect liver transplantation patient's renal function impairment incidence rate by analyzing patients'perioperative data.Methods The medical treatment in this research is permitted by Ethics Committee of the First Affiliated Hospital of Chongqing Medical University. The data collection process lasted from 2002.2 to 2009.5 in The First Affiliated Hospital of Chongqing Medical University. 54 samples were collected excluding patients who got kidney disease and hypertension, diabetes. The 15 indicators:age, cancer or cirrhosis, Child-Pugh degree, Liver transplantation method, CLCVP(controlled low central venous pressure), the renal function recovery time, the renal function after surgery, Hypotension, blood loss, blood transfusion volume, transfusion volume, urine volume, operation time, Anhepatic period and Pulmonary infection were recorded for statistical analysis. The Kaplan-Meier approach would be taken to plot the chart, and log-rank check was necessary. These samples were categorized into three groups: N Group, which represented post-op patients with normal renal function; ARD Group, which represented patients with ARD; and ARF Group, which represented patients with ARF. All the factors affecting renal functions would be recorded in frequency table, and followed be ranking and checking. All 13 factors excluding the renal function recovery time and the renal function after surgery as covariates will be given a number as equivalent variable, and be taken into the Logistic regression model. P<0.05 means the factors has statistical significance on patients renal recovery, and it was the condition of the screening process which all the factors will go through. Then, we put the risk factors that had statistically significant in Single factor screening into Logistic regression model at the same time,get the risk factors'B and OR value, and do likelihood ratio test of the model as well. Finally, the factors affecting renal function impairment incidence rate have been discovered. Also, the value of B, OR and the number given to covariates have been used to judge the property of covariates. The protective covariates and destructive covariate have been taken into Logistic regression model to see the interaction.Results (1)Ranking and checking shows that Hypotension, blood loss, blood transfusion volume, transfusion volume, and pulmonary infection are the cause of statistical significance among N group, ARD group, ARF group, while age, cancer or cirrhosis, Child-Pugh degree, Liver transplantation method, CLCVP, operation time, Anhepatic period, urine volume are not. (2)The renal function recovery curve:The curve shows that renal function recovery is faster on patients who has no hypotension than the one who has hypotension. The same situation happens on patients who'volume of bleeding more than 4000 ml or get pulmonary infection. ( 3 ) Logistic regression :â‘ Single factor Logistic regression : Hypotension, blood loss, blood transfusion volume, transfusion volume, and pulmonary infection has statistical significance on patients'renal function impairment incidence rate, but age, cancer or cirrhosis, Child-Pugh degree, Liver transplantation method, CLCVP,operation time, Anhepatic period, urine volume are not.â‘¡Multivariate Logistic regression: Hypotension(B=-2.998,OR=0.050), blood transfusion volume,(B=-2.025,OR=0.132)and pulmonary infection(B=-2.201,OR=0.111)has statistical significance affect on renal function impairment incidence rate. Likelihood ratio test shows that the logistic regression model is fitting(P<0.05).â‘¢The interaction of covariate: Hypotension, blood transfusion volume, and pulmonary infection still remains the same after introducing CLCVP in Logistic regression model, but blood loss and transfusion volume had no statistics significant. In single Logistic regression, the 5 factors both have statistics significant.Conclusions (1) Factors which affect liver transplantation patient's renal function impairment incidence rate sort by intensity are:â‘  hypotensionâ‘¡pulmonary infectionâ‘¢massive blood transfusion (2) CLCVP could protect renal function by reducing blood loss and massive infusion,but can not offset the rennal impairment of massive blood transfusion , hypotension, pulmonary infection.