Relationship Between Intraoperative Hypotension and Acute Kidney Injury After Living Donor Liver Transplantation: A Retrospective Analysis
Relationship Between Intraoperative Hypotension and Acute Kidney Injury After Living Donor Liver Transplantation: A Retrospective Analysis
复制标题
DOI：
10.1053/j.jvca.2016.12.002
复制
发表时间：
2017-04-01
影响因子：
2.8
通讯作者：
Segawa, Hajime
中科院分区：
文献类型：
--
作者：
Mizota, Toshiyuki;Hamada, Miho;Segawa, Hajime
目的：急性肾损伤（阿基）是肝移植（LT）后常见的并发症，对预后有显著影响。虽然已经确定了LT后阿基的几个风险因素，但术中血流动力学状态对LT后阿基的影响仍然未知。因此，作者的目的是调查血液动力学参数之间的关系，在LT和术后阿基设计：一项回顾性观察研究。设置：大学医院。参与者：患者谁接受活体供肝LT（n = 231）。干预措施：无。测量和主要结果：严重阿基（根据最近的指南2-3期）的主要结果。使用多变量逻辑回归分析控制混杂变量，以获得术中血流动力学参数（平均动脉压[MAP]和心脏指数）与重度阿基之间的独立关系。重度AM的患病率为30.7%。手术期间最低MAP可独立预测重度阿基（校正比值比，每降低10 mmHg为2.11 [95%置信区间，1.32-3.47]; p = 0.002）。基于各种患者或手术变量的亚组分析和广泛的敏感性分析显示了基本相似的结果。重度低血压（MAP < 40 mmHg），即使持续时间少于10分钟，也与重度阿基显著相关（校正比值比，3.80 [95%置信区间，1.17-12.30]; p = 0.026）。与此相反，最低心脏指数并没有显着相关的严重AM.Conclusions：作者发现了一个独立的关系，术中低血压的程度和严重阿基的风险活体供肝移植受体。重度低血压（即使持续时间较短）与重度阿基显著相关。(C)2017爱思唯尔公司All rights reserved.
Objective: Acute kidney injury (AKI) is common after liver transplantation (LT) and has a significant impact on outcomes. Although several risk factors for post-LT AKI have been identified, the effect of intraoperative hemodynamic status on post-LT AKI remains unknown. Therefore, the authors aimed to investigate the relationship between hemodynamic parameters during LT and postoperative AKI.Design: A retrospective observational study.Setting: University hospital.Participants: Patients who underwent living donor LT (n = 231).Interventions: None.Measurements and Main Results: Severe AKI (stages 2-3 according to recent guidelines) was the primary outcome. Multivariable logistic regression analysis was used to control for confounding variables to obtain the independent relationship between intraoperative hemodynamic parameters (mean arterial pressure [MAP] and cardiac index) and severe AKI. The prevalence of severe AM was 30.7%. Nadir MAP during the surgery was independently predictive of severe AKI (adjusted odds ratio, 2.11 [95% confidence interval, 1.32-3.47] per 10-mmHg decrease; p = 0.002). Subgroup analyses based on various patient or operative variables and extensive sensitivity analyses showed substantially similar results. Severe hypotension (MAP < 40 mmHg), even for fewer than 10 minutes, was related significantly to severe AKI (adjusted odds ratio, 3.80 [95% confidence interval, 1.17-12.30]; p = 0.026). In contrast, nadir cardiac index was not related significantly to severe AM.Conclusions: The authors found an independent relationship between degree of intraoperative hypotension and risk of severe AKI in living donor LT recipients. Severe hypotension, even for a short duration, was related significantly to severe AKI. (C) 2017 Elsevier Inc. All rights reserved.