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

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.

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).

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.