Correlation Between Preoperative NT-proBNP And Acute Kidney Injury After Liver Transplantation

Objective:Acute kidney injury(AKI),a common complication after liver transplantation(LT),has a significant impact on the long-term prognosis of liver transplant patients.This study aimed to investigate the relationship between preoperative N-terminal pro-Brain natriuretic peptide(NT-pro BNP)and AKI after LT,as well as the perioperative risk factors that affect AKI and provide a diagnostic reference indicators for the early prevention of AKI after LT.Methods:Medical records of adult patients who underwent liver transplantation between September 13,2020,and June 30,2022,were obtained from the Anesthesia Management System of The First Hospital of Jilin University,and eligible cases were selected.Perioperative data include the basic information such as age,gender,body mass index(BMI),blood types,etiology,combined chronic diseases,history of previous abdominal surgery,preoperative hepatic encephalopathy and preoperative laboratory tests such as estimated glomerular filtration rate(e GFR),blood urea nitrogen(BUN),serum creatinine(Scr),TBIL,AST,ALT,albumin,hemoglobin level,platelets count,C-reactive protein(CRP),NT-pro BNP,fibrinogen concentration,international normalized ratio(INR),fasting blood glucose,serum chloride,serum sodium,serum calcium,serum potassium,and ammonia concentrations;intraoperative clinical data include operating time,central venous pressure,mean arterial pressure(MAP),heart rate,intraoperative fluid infusion(crystalloids or colloids,for example),intraoperative blood product transfusion volume(e.g.human albumin,red blood cells,plasma,platelets,thrombospondin complexes,cryoprecipitate,fibrinogen,autologous blood),bleeding volume,urine volume,anesthesia method,ASA classification,duration of anesthesia,and extra anesthesia drugs.Postoperative indicators include peak creatinine values within 48 hours and 7 days after surgery,peak NT-pro BNP levels within seven days after surgery,duration of mechanical ventilation,infection,whether the patient was transferred to ICU or not,and length of stay in the ICU and general ward.The patients were divided into AKI and non-AKI groups based on the Kidney Disease: Improving Global Outcomes(KDIGO)criteria for postoperative AKI.We investigated the relationship between preoperative NT-pro BNP levels and AKI after LT as well as the perioperative risk factors for AKI after LT by using univariate analysis and multivariate Logistic regression analysis.Results:A total of 144 patients included in this study,22 patients(15.3%)developed postoperative AKI,and 122 patients(84.7%)did not develop postoperative AKI.Univariate analysis of differences between the AKI and non-AKI groups revealed that patients in the AKI group were older,had a higher BMI,preoperative combined diabetes,a higher preoperative NT-pro BNP concentration,a lower preoperative fibrinogen level,a longer operation time,and a higher intraoperative bleeding volume with significant differences(P<0.05).Multifactorial regression analysis showed that high preoperative NTpro BNP concentration was an independent risk factor for AKI after LT after adjustment for age,preoperative combined diabetes,BMI,preoperative fibrinogen level,length of surgery,and intraoperative bleeding volume.Furthermore,age(OR=5.399,95%CI 1.094-26.643,P=0.038),preoperative combined diabetes(OR=5.361,95%CI 1.333-21.564,P=0.018),preoperative fibrinogen level(OR=5.352,95%CI 1.177-24.335,P=0.030),operative time(OR=8.021,95%CI 1.333-21.564,P=0.018),and intraoperative bleeding volume(OR=7.436,95%CI 1.212-45.619,P=0.030)were risk factors for the development of AKI in liver transplant patients after surgery.Conclusions:A high preoperative NT-pro BNP concentration is an independent risk factor for AKI after liver transplantation.Age,preoperative comorbid diabetes,a low preoperative fibrinogen level,a large intraoperative bleeding volume,and an increase in operation time are all risk factors for AKI after liver transplantation.