Risk factors of acute renal failure after liver transplantation
Risk factors of acute renal failure after liver transplantation
复制标题
DOI：
10.1038/sj.ki.5000216
复制
发表时间：
2006-03-01
影响因子：
19.6
通讯作者：
Parrilla, P
中科院分区：
文献类型：
--
作者：
Cabezuelo, JB;Ramírez, P;Parrilla, P
本研究的目的是确定原位肝移植术后急性肾功能衰竭（ARF）的危险因素。我们回顾了184例连续奥尔特。术后ARF定义为S-肌酐（S-Cr）持续升高50%或以上。将患者分为术后早期ARF（E-ARF）（第1周）和术后晚期ARF（L-ARF）（第2 ~ 4周）。术前变量包括年龄、性别、合并症、奥尔特适应证、Child-Pugh分期、器官共享联合网络、血、尿分析和供体资料。术中变量为收缩期动脉压、平均动脉压、肺毛细血管楔压、心脏指数和全身血管阻力指数。手术技术、输血数量、肾上腺素能激动剂药物的需要和术中并发症也很重要。术后变量包括重症监护室的住院时间、机械通气时间、肝移植功能障碍、肾上腺素能激动剂药物的需求、输注的血液制品单位、急性排斥反应发作、再次手术和细菌感染。首先进行单因素统计分析，然后进行Logistic回归分析。E-ARF的危险因素为：移植前ARF（比值比（OR）= 10.2，P = 0.025）、S-白蛋白（OR = 0.3，P = 0.001）、多巴胺治疗持续时间（OR = 1.6，P = 0.001）和肝移植物II-IV级功能障碍（OR = 5.6，P = 0.002）。再次手术（OR = 3.1，P = 0.013）和细菌感染（OR = 2.9，P = 0.017）是L-ARF的危险因素。E-ARF的发生受术前因素如ARF和低白蛋白血症以及术后因素如肝功能障碍和多巴胺治疗时间延长的影响。L-ARF的预测因素与E-ARF不同，与细菌感染和再次手术等术后原因相对应。
The objective of this study was to determine the risk factors of postoperative acute renal failure (ARF) in orthotopic liver transplantation (OLT). We reviewed 184 consecutive OLT. Postoperative ARF was defined as a persistent rise of 50% increase or more of the S-creatinine (S-Cr). The patients were classified as early postoperative ARF (E-ARF) (first week) and late postoperative ARF (L-ARF) (second to fourth week). Preoperative variables were age, sex, comorbidity, indication for OLT, Child-Pugh stage, united network for organ sharing status, analysis of the blood and urine, and donor's data. Intraoperative variables were systolic arterial pressure, mean arterial pressure, pulmonary capillary wedge pressure, cardiac index, and systemic vascular resistance index. Surgical technique, number of blood products transfused, need for adrenergic agonist drugs, and intraoperative complications were also important. Postoperative variables were duration of stay in the intensive care unit, time on mechanic ventilation, liver graft dysfunction, need for adrenergic agonist drugs, units of blood products infused, episodes of acute rejection, re-operations, and bacterial infections. Firstly we carried out a univariate statistical analysis, and secondly a logistic regression analysis. The risk factors for E-ARF were: pretransplant ARF (odds ratio (OR) = 10.2, P = 0.025), S-albumin (OR = 0.3, P = 0.001), duration of treatment with dopamine (OR = 1.6, P = 0.001), and grade II-IV dysfunction of the liver graft (OR = 5.6, P = 0.002). The risk factors for L-ARF were: re-operation (OR = 3.1, P = 0.013) and bacterial infection (OR = 2.9, P = 0.017). The development of E-ARF is influenced by preoperative factors such as ARF and hypoalbuminemia, as well as postoperative factors such as liver dysfunction and prolonged treatment with dopamine. The predicting factors of L-ARF differ from E-ARF and correspond to postoperative causes such as bacterial infection and surgical re-operation.