Effects Of Retrograde Perfusion On Early Renal Function After Liver Transplantation

Objective: To investigate the effect of retrograde perfusion of the inferior vena cava on early renal function after liver transplantation.Methods: Chose 103 cases of liver transplantation with normal serum creatinine and blood urea nitrogen during January 2001 to December 2012 in Fuzhou General Hospital of Nanjing Military Region.Then they are divided into two groups--the group of classic orthotopic liver transplantation(ie,group A)and the group of inferior vena cava reverse perfusion orthotopic liver transplantation(ie,group B)according to whether it took the methods of inferior vena cava retrograde perfusion during the operation,and the number of cases in both groups is 26 and 77,respectively.Recording the data of the two groups,including the age(year),sex,the primary disease and liver function(MELD)scoring before the surgery,and the time of intraoperative inferior vena cava blocking(minutes),the amount of infusion quantity(L)and blood transfusion during operation(L),and the urine volume(ml),serum creatinine and blood urea nitrogen data of first to seventh,fourteenth,twenty-eighth days after operation.Then the above factors is analyzed whether there is difference between the group A and B by using the statistical retrospective analysis,and if there is difference between them,whether it is statistically significant.Results:1.There were no significant differences in the preoperative age(P=0.056),sex(P=0.058),the primary disease(P=0.336),liver function MELD score(P=0.509),preoperative serum creatinine(P=0.854)and preoperative blood urea nitrogen(P=0.073)between the two groups(P> 0.05).2.The inferior vena cava occlusion time of the two groups: the group A(65.31±7.93min),the group B(47.22±8.05min),and the difference was statistically significant(P<0.001,P<0.05).3.The total amount of intraoperative infusion of the two groups: the group A(7.75±2.09L),the group B(6.17±2.28L),and the difference between them was statistically significant(P=0.002,P<0.05).4.The total amount of blood transfusion products of the two groups: the group B(3.78±2.59L),the group A(7.32±2.92L),and the difference was statistically significant(P<0.001,P<0.05).5.The urine volume of the two groups(m L): It was lower in the group B than that in the group A at first day(group A:1336±509,group B:1009±356)and second day((group A: 1618±609,group B: 1275±481)after operation,and the difference was statistically significant(P<0.05).But there was no significant difference between the two groups at 3rd(group A:1428±429,group B:1563±513),4th(group A:1726 ± 666,group B:1730 ± 629),5th(group A:1632 ± 516,group B:1647±645),6th(group A:1617±544,group B:1529±616),7th(group A:1526±724,group B:1534±570),14th(group A:1610±401,group B:1473±330),28th(group A:1590±214,group B:1466±298)days after operation(P>0.05).6.The serum creatinine data of the two groups after operation(umol/L): there was no significant difference between the two groups on the first day(group A: 103.00±49.42,group B: 91.92±24.32)after operation(P>0.05).The serum creatinine in the group B was lower than that in group A at 2nd(group A: 124.15±60.39,group B: 97.34±34.73),3rd(group A: 100.42±36.95,group B: 88.31±21.90),4th(group A: 91.04±41.55,group B: 76.00±26.91),5th(group A: 82.23±37.42,group B: 66.56±21.87),6th(group A: 76.92±37.16,group B: 65.29±20.54),7th(group A: 74.92±37.61,group B: 63.58±18.55),14th(group A: 70.73±24.14,group B: 61.43±11.69),and 28th(group A: 70.42±20.34,group B: 59.40 ± 8.57)days after operation and the difference was statistically significant(P<0.05).7.The blood urea nitrogen data of the two groups after operation(mmol/L): It was significantly lower in the group B than those in the group A at the 1st(group A: 10.48±3.28,group B: 7.01±2.22),2nd(group A: 14.94±6.76,group B: 10.95±4.98),3rd(group A: 15.88±7.03,group B: 12.79±6.68),,4th(group A: 14.77±6.99,group B: 11.46±5.92),,5th(group A: 13.27±6.31,group B: 9.96±4.22),,6th(group A: 12.78±5.66,group B: 9.20±3.98),7th(group A: 11.17±6.75,group B: 8.60±4.20),14th(group A: 10.08±6.33,group B: 7.34±2.88)and the 28 th day(group A: 9.15±6.42,group B: 6.09±4.21)after operation and the difference between the two groups was statistically significant(P<0.05).8.The incidence of acute renal failure in the early stage of liver transplantation with normal serum creatinine and blood urea nitrogen was 3.88%(group A: 11.54%,group B: 1.30%),and the difference between the two groups was statistically significant(P<0.05).Conclusion:1.The incidence of early acute renal failure after liver transplantation was 3.88% in patients of end-stage liver disease with normal preoperative serum creatinine and blood urea nitrogen.2.Compared with the classical orthotopic liver transplantation,the effect of the inferior vena cava perfusion liver transplantation on the postoperative renal function is smaller,which is more beneficial to the recovery of renal function after operation.