Clinical Analysis of Impact of Intraoperative Hepatic Blood Inflow on Acute Kidney Injury following Allogeneic Liver Transplantation

Abstract

Background Acute kidney injury (AKI) is a major and severe complication following allogeneic liver transplantation and is associated with increased postoperative morbidity and mortality. With proposal of RIFLE (Risk, Injury, Failure, Loss, End-stage kidney disease) and AKIN (Acute Kidney Injury Network) standards, the diagnosis of AKI has been significantly improved. However, the risk factors and the prognosis factors of AKI remain uncertain, the relativity of intraoperative hepatic blood flow and acute renal injury following liver transplantation hasn't been discussed yet. Method 140 patients who underwent allogeneic liver transplantation at first hospital of China Medical University from January 2006 to October 2016 was analyzed. AKI was diagnosed and graded by AKIN standard. Incidence rate, risk factors, prognosis factors of AKI were investigated. Results Of the 140 cases of allogeneic liver transplantation, the overall incidence rate of AKI was 34.3%(n=48). Multivariate logistic regression analysis showed that preoperative TBil, cold ischemia time, intraoperative RBC infusion unit, intraoperative mean hepatic artery and portal blood flow were risk factors of AKI following liver transplantation. Anhepatic phase was independent risk factor between AKI stage III and AKI stage I /II. Compared with patients whose renal function was fully recovered in 30 days following allogeneic liver transplantation, postoperative TBil, postoperative MELD score, AKI stage III and postoperative CRRT were significantly higher and intraoperative minimum, mean, maximum portal blood flow were obviously lower in patients whose renal function was partially recovered. Conclusion Incidence rate of AKI following liver transplantation is relatively high, and is closely related to multiple perioperative risk factors such as intraoperative blood flow of hepatic artery and portal vein. Anhepatic phase is the independent risk factor of sever AKI and the early recovery of renal function is worse in patients with lower intraoperative portal blood flow.