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中华移植杂志(电子版)

中华移植杂志(电子版) ›› 2020, Vol. 14 ›› Issue (02) : 92 -95. doi: 10.3877/cma.j.issn.1674-3903.2020.02.007

所属专题： 文献；

论著

心脏死亡器官捐献肝移植术后并发急性肾损伤危险因素分析
向丽1, 卢长江2, 胡杨科1, 吴胜东2, 陆才德2,†()   
  1. 1. 315000　宁波大学医学院
    2. 315000　宁波市医疗中心李惠利医院肝胆胰外科
  • 收稿日期:2019-09-17 出版日期:2020-04-25
  • 通信作者: 陆才德
  • 基金资助:
    宁波市医学科技计划项目(2016A14); 宁波市科技创新团队(2013B82010); 宁波市医疗卫生品牌学科(PPXK2018-03)

Analysis of risk factors for acute kidney injury after donation after cardiac death liver transplantation

li Xiang1, Changjiang Lu2, Yangke Hu1, Shengdong Wu2, Caide Lu2,†()   

  1. 1. Medical College of Ningbo University, Ningbo 315000, China
    2. Department of Hepatobiliary and Pancreatic Surgery, Li Huili Hospital, Ningbo Medical Center, Ningbo 315000, China
  • Received:2019-09-17 Published:2020-04-25
  • Corresponding author: Caide Lu
  • About author:
    Corresponding author: Lu Caide, Email:
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引用本文：

向丽, 卢长江, 胡杨科, 吴胜东, 陆才德. 心脏死亡器官捐献肝移植术后并发急性肾损伤危险因素分析[J]. 中华移植杂志(电子版), 2020, 14(02): 92-95.

li Xiang, Changjiang Lu, Yangke Hu, Shengdong Wu, Caide Lu. Analysis of risk factors for acute kidney injury after donation after cardiac death liver transplantation[J]. Chinese Journal of Transplantation(Electronic Edition), 2020, 14(02): 92-95.

目的

探讨心脏死亡器官捐献(DCD)肝移植术后并发急性肾损伤(AKI)的危险因素。

方法

回顾性分析2012年1月至2018年11月宁波市医疗中心李惠利医院肝胆胰外科159例DCD肝移植受者临床资料，根据改善全球肾脏病预后组织临床实践指南中AKI诊断标准将159例受者分为AKI组(34例)和对照组(125例)。采用两独立样本t检验比较两组受者年龄和术前血清白蛋白。采用Wilcoxon符号秩和检验比较两组受者术前终末期肝病模型(MELD)评分、术前体质指数(BMI)、供肝冷/热缺血时间、术中输液量、术中出血量、术中输血量、术中尿量、手术时间、术中去甲肾上腺素总用量及总住院天数。采用卡方检验比较两组受者性别、术前乙型肝炎、术中低血压、术后感染、肝移植术式及术后再次手术情况。将单因素分析中有统计学差异的变量纳入Logistic回归进行多因素分析。P<0.05为差异有统计学意义。

结果

肝移植术后AKI发生率为21.4%(34/159)。单因素分析结果表明，AKI组与对照组受者术前MELD评分、术前血清白蛋白、术中输液量、术中出血量、术中尿量、手术时间、术中低血压及术后再次手术差异均有统计学意义(Z＝2.763, t＝－2.250, Z＝2.040, Z＝2.092, Z＝－3.303, Z＝－2.170, χ2＝8.227, χ2＝5.294, P均<0.05)。Logistic回归多因素分析结果显示：术前MELD评分、术前血清白蛋白、术中尿量和手术时间是DCD肝移植术后并发AKI的独立危险因素，差异均有统计学意义(P均<0.05)。

结论

DCD肝移植术前应改善受者一般情况，提高围手术期营养水平，术中控制液体出入量，合理使用利尿剂和缩短手术时间，以降低受者术后AKI发生率。

关键词: 肝移植, 急性肾损伤, 危险因素, 心脏死亡器官捐献
Objective

To explore the risk factors of acute kidney injury (AKI) after donation after cardiac death (DCD) liver transplantation.

Methods

A retrospective analysis of clinical data of 159 DCD liver transplant recipients from the Department of Hepatobiliary and Pancreatic Surgery at Li Huili Hospital of Ningbo Medical Center from January 2012 to November 2018 was performed. The recipients were divided into AKI group (34 cases) and control group (125 cases) according to the criteria of Kidney Disease: Improving Global Outcomes. Two independent sample t test was used to compare the age and serum albumin before transplantation of the 2 groups. Wilcoxon signed rank sum test was used to compare the preoperative model for end-stage liver disease (MELD) score, preoperative body mass index (BMI), donor liver cold/warm ischemic time, intraoperative infusion volume, intraoperative bleeding volume, and intraoperative intermediate blood transfusion, intraoperative urine output, operation time, total intraoperative norepinephrine dosage and total hospital stay. Chi-square test was used to compare the gender, preoperative hepatitis B, intraoperative hypotension, postoperative infection, liver transplantation method and postoperative reoperation. The variables with statistical difference in univariate analysis were included in Logistic regression for multivariate analysis. P<0.05 was considered statistically significant.

Results

The incidence of AKI after liver transplantation was 21.4% (34/159). Univariate analysis showed that the indexes including the preoperative MELD score, preoperative serum albumin, intraoperative infusion volume, intraoperative blood loss, intraoperative urine volume, surgical time, intraoperative hypotension and postoperative reoperation between the 2 groups had statistical significance (Z=2.763, t=-2.250, Z=2.040, Z=2.092, Z=-3.303, Z=-2.170, χ2=8.227, χ2=5.294, P all <0.05). Logistic regression multivariate analysis showed the indexes including the preoperative MELD score, preoperative serum albumin, intraoperative urine volume and operation time were independent risk factors for AKI after DCD liver transplantation, and the differences were statistically significant (P all<0.05).

Conclusions

For DCD liver transplantation, the general condition of the recipient before transplantation and the nutritional level during the perioperative period should be improved, and the amount of fluid should be controlled during the operation, the use of diuretics and the operation time should be shortened to reduce the incidence of AKI after transplantation.

Key words: Liver transplantation, Acute kidney injury, Risk factor, Donation after cardiac death
表1 DCD肝移植术后并发AKI危险因素单因素分析结果
组别 例数 性别(男/女，例) 年龄(±s，岁) 术前MELD评分[M(Min，Max)，分] 术前血清白蛋白(±s，g/L)
AKI组 34 25/ 9 54±9 16(6，41) 39±9
对照组 125 103/22 52±9 12(6，37) 36±7
χ2/Z/t值 － 1.340 －1.23 2.763 －2.250
P值 － >0.05 >0.05 <0.05 <0.05
组别 例数 BMI[M(Min，Max)，kg/m2] 术前乙型肝炎(是/否，例) 供肝冷缺血时间[M(Min，Max)，h] 供肝热缺血时间[M(Min，Max)，min]
AKI组 34 23(17，35) 27/ 7 6.2(3.0，18.0) 10(5，19)
对照组 125 23(16，31) 92/33 6.5(2.5，15.5) 10(3，28)
χ2/Z/t值 － 0.029 0.480 －0.175 0.266
P值 － >0.05 >0.05 >0.05 >0.05
组别 例数 术中输液量[M(Min，Max)，mL] 术中出血量[M(Min，Max)，mL] 术中输血量[M(Min，Max)，mL] 术中尿量[M(Min，Max)，mL]
AKI组 34 6 535(1 680，21 090) 2 000(300，15 000) 2 800(0，12 430) 1 040(100，3 300)
对照组 125 5 345(1 200，25 600) 1 500(200, 9 000) 1 700(0，15 000) 1 625(425，4 100)
χ2/Z/t值 － 2.040 2.092 －2.443 －3.303
P值 － <0.05 <0.05 >0.05 <0.05
组别 例数 手术时间[M(Min，Max)，min] 去甲肾上腺素总用量[M(Min，Max)，mg] 术中低血压(有/无，例) 术后感染(有/无，例)
AKI组 34 360(260，650) 110(0，1 203) 23/11 15/19
对照组 125 420(240，810) 149(0，1 643) 50/75 38/87
χ2/Z/t值 － －2.170 －0.555 8.227 2.263
P值 － <0.05 >0.05 <0.05 >0.05
组别 例数 肝移植术式(经典/背驮式，例) 术后再次手术(有/无，例) 总住院天数[M(Min，Max)，d]
AKI组 34 11/23 7/ 27 24(11，60)
对照组 125 31/94 9/116 25( 7，62)
χ2/Z/t值 － 0.784 5.294 －0.842
P值 － >0.05 <0.05 >0.05
表2 DCD肝移植术后并发AKI危险因素多因素分析结果
相关因素 回归系数(β) OR值 95%可信区间 P值
术前MELD评分(分) 0.061 1.063 1.003～1.128 <0.05
术前血清白蛋白(g/L) 0.089 1.093 1.020～1.171 <0.05
术中输液量(mL) 0.000 1.000 1.000～1.000 >0.05
术中出血量(mL) 0.000 1.000 1.000～1.001 >0.05
术中尿量(mL) －0.001 0.999 0.998～1.000 <0.05
手术时间(min) －0.008 0.992 0.986～0.998 <0.05
术中有无低血压(例) 0.483 1.622 0.587～4.482 >0.05
术后再次手术(例) 0.894 2.445 0.564～10.608 >0.05
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