Analysis Of Influence Of Donor Types And Risk Factors Of Acute Kidney Injury After Liver Transplantation

Objective:For the patients of end-stage liver disease, the only potentially curative treatment is liver transplantation currently. Acute kidney injury (AKI) is one of the most common postoperative complications, which is closely related to the occurrence of chronic kidney diseases and mortality. Donation after cardiac death (DCD) and donation after brain death (DBD) are two main organ resources, and the aim of this study is to analyze the influence of donor types and risk factors of AKI after liver transplantation.Methods:267 cases of end-stage liver disease who had underwent liver transplantation were collected from October 1st,2010 to January 31th,2016 in the First Affiliated Hospital, School of Medicine, Zhejiang University. Two groups was divided based on the organ resources, DBD group and DCD group. Then the DCD group was divided into two according to the occurrence of postoperative AKI, AKI group and No-AKI group. A retrospective study was conducted to analyze the clinical data of these patients. Observation indexes mainly included cold ischemic time, warm ischemic time, operation time, intra-operative bleeding, intra-operative blood infusion, duration of intensive care unit stays and so on.Results:The clinical data of preoperative donors、preoperative recipients and transplantation operation were found to be of no statistical difference after 1:1 cases match between the DBD group and DCD group. Compared to the DBD group, the incidence of postoperative AKI was higher in the DCD group (DBD:37.8%, DCD: 48.6%,P=0.348). The preoperative mean level of serum creatinine of recipients was higher in the AKI group than the No-AKI group (P=0.035); Statistical difference was also found in the composition of donor death causes between the two groups. Donor warm ischemia time (NO.3) of the No-AKI group was shorter than the AKI group’s (5.4±2.5min vs 6.2±3.1min, P=0.034); Both the volume of intra-operative bleeding and plasma infusion of the AKI group were more than the No-AKI group’s (1781±1358ml vs 1407±1105ml, P=0.025; 1497±614ml vs 1300±524ml, P=0.010). Logistic regression analysis showed that the above indexes were closely related to the occurrence of AKI after liver transplantation.Conclusion:Compared to using graft of DBD type, patients who use grafts of DCD type may be confronted with higher risk of AKI occurrence after liver transplantation. In terms of DCD type, some parameters such as worse condition of preoperative renal function of recipients, grafts from donors of cerebrovascular accident, longer warm ischemia time of grafts and larger volume of intra-operative bleeding and plasma infusion are recognized as the risk factors of postoperative AKI occurrence.