Acute kidney injury after liver transplantation: incidence and risk factors

doi:10.3969/j.issn.1006-7795.2018.01.004

Abstract

Abstract: Objective To investigate clinical characteristics and risk factors of acute kidney injury (AKI) in patients following liver transplantation. The clinical outcomes of patients with AKI were also studied.Methods This was a retrospective observational study with data collected from intensive care unit (ICU) at Beijing Friendship Hospital, Capital Medical University. All the adult patients following liver transplantation admitted to ICU from June 1, 2013 to October 31, 2016 were included. Patients under kidney transplantation at the same time or ever for kidney transplantation or underwent retransplantation or with end stage renal dysfunction relying on renal replacement therapy or diagnosed as AKI before transplantation were excluded. AKI was diagnosed and classified according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Information recorded from patients' charts included demographic characteristics, previous history of hypertension, diabetes mellitus, previous liver disease, and model for end-stage liver disease (MELD) score. Preoperative laboratory values were also recorded:creatinine, albumin, total bilirubin(Tbil),alanine transaminase (ALT) and aspartate transaminase (AST). From the intraoperative period, we recorded the following data:duration of surgery, cold/warm ischemia time, fluid balance. Postoperative factors included:days in ICU, overall in-hospital stay and 28 days mortality rates. Univariate analysis was used to identify the difference between the two groups, and then logistic regression analysis was used to estimate the risk factors of acute kidney injury, and receiver operating characteristic(ROC) curve was used to form prediction model.Results Among the 279 patients after liver transplantation, 124 patients were adult(≥ 18 years),with 68 (54.8%) developed AKI according to KDIGO category:66.2% belonged to the stage 1, 13.2%(n=9) to the stage 2, and 20.6% (n=14) to the stage 3. Multivariate logistic regression analysis revealed that the development of AKI was associated with intraoperative hypotension duration(odd ratio,OR=1.020), excessive loss of blood(OR=1.036) and fluid balance during surgery(OR=1.015). The cut off value was 27.5 min, 32.5 mL/kg, and 31.2 mL/kg. Area under curve(AUC) was 0.662 (P=0.002, 95% CI:0.567-0.757), 0.637 (P=0.009, 95% CI:0.540-0.734), 0.624 (P=0.017, 95% CI:0.526-0.723).Conclusion The incidence rate of AKI was 54.8%. The risk factors were intraoperative hypotension duration and excessive loss of blood and fluid balance during operation. AKI is independently associated with longer duration of hospitalization.

Key words: acute kidney injury (AKI), liver transplantation, risk factors

CLC Number:

R617

Yue Zhu, Li Ang, Liu Pei, Bai Jing, Zhuang Haizhou, Duan Meili. Acute kidney injury after liver transplantation: incidence and risk factors[J]. Journal of Capital Medical University, 2018, 39(1): 14-20.

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URL: https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/10.3969/j.issn.1006-7795.2018.01.004

https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/Y2018/V39/I1/14

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