Abstract:

Objective To detect risk factors for early acute renal failure（ARF）after orthotopic liver transplantation（OLT）. Methods 189 patients who underwent liver transplantation in our center were analyzed retrospectively. They were divided into ARF and non-ARF groups according to serum creatinine level early after OLT. Peri-operative clinical and laboratory variables of these two groups were compared with univariate analysis，and then variables with significantly statistic difference were further studied with logistic regression analysis. Results 68 （36.0%）of the 189 patients develop post-OLT early ARF. Age，body mass index（BMI），pre-OLT serum creatinine，model for end-stage liver disease（MELD）score，minimum mean arterial pressure during operation，low blood pressure duration，blood products transfusion volume，urine output during operation were significantly different between these two groups with univariate analysis（all P＜0.05）. Logistic regression analysis showed low bloodpressure time during operation and urine output were independent risk factors for development of early ARF after OLT（both P＜0.05）. In patients with early ARF，the duration of mechanical ventilation was prolonged，length of stay in the transplant intensive care unit（TICU）was longer than that in non-ARF group（both P＜0.05）. Conclusions Patients with early ARF had prolonged duration of mechanical ventilation and longer stay in TICU. Low blood pressure during operation and urine output are independent risk factors for development of early ARF after OLT.

Key words:

摘要：

目的 探讨肝移植术后早期急性肾功能衰竭（ARF）的危险因素。方法 回顾性分析 189 例 肝移植患者的临床资料，依据术后早期肾功能分为 ARF 组和非 ARF 组，比较两组之间围手术期的临床及实 验室指标变化，进行单因素分析，对单因素分析中 P＜0.05 的变量进行 Logistic 回归分析。结果 189 例肝 移植患者中 68 例（36.0%）发生早期 ARF，单因素分析表明年龄、体重指数（BMI）、术前血肌酐、终末期 肝病（MELD）评分、术中最低平均动脉压、低血压持续时间、血液制品输注总量、尿量两组之间差异有统 计学意义（均 P＜0.05）。Logistic 回归分析提示，术中低血压持续时间和术中尿量是肝移植术后 ARF 的独 立危险因素（均 P＜0.05）。ARF 组患者术后机械通气时间、移植重症监护病房（TICU）滞留时间与非 ARF 组比较差异有统计学意义（均 P＜0.05）。结论 肝移植术后早期 ARF 的患者术后机械通气时间及 TICU 滞 留时间长，患者术中低血压持续时间和术中尿量是肝移植术后 ARF 发生的独立危险因素。

关键词: