肝移植术后急性肾损伤最新研究进展

Latest Research Progress on Acute Kidney Injury after Liver Transplantation

摘要: 近年来，随着肝移植技术的持续发展，肝移植已经成为治疗肝脏终末期良恶性疾病的最有效方式，经典原位肝移植、背驮式肝移植、劈离式肝移植、辅助性肝移植等术式亦日趋成熟。肝移植术后急性肾损伤(Acute Kidney Injury, AKI)是常见且重要的并发症，其发生率可高达10%~90%，与住院时间延长、医疗费用增加及病死率上升密切相关。随着肝移植技术的普及，AKI的防治成为研究热点。本文系统回顾了2011年至2025年间国内外关于肝移植术后AKI危险因素、预测模型及干预措施的研究进展，从术前、术中、术后三个维度梳理其影响因素，并对现有预测模型进行评估，以期为临床早期识别高危患者、优化围术期管理提供参考。

Abstract: In recent years, with the continuous evolution of liver transplantation techniques, this procedure has established itself as the most efficacious therapeutic modality for end-stage benign and malignant liver pathologies. Surgical approaches, including classical orthotopic liver transplantation, piggyback liver transplantation, split liver transplantation, and auxiliary liver transplantation, have attained a high degree of technical maturity. Postoperative acute kidney injury (AKI) represents a prevalent and consequential complication following liver transplantation, significantly impacting patient prognosis. Its reported incidence varies widely from 10% to 90% and is strongly correlated with prolonged hospitalization, escalated healthcare expenditures, and elevated mortality. As liver transplantation gains broader clinical application, the prevention and management of AKI have become a focal point of investigative efforts. This article provides a systematic review of the advancements in research—both domestic and international—from 2011 to 2025 concerning the risk factors, predictive models, and interventional strategies for AKI after liver transplantation. The analysis is structured along three temporal dimensions: preoperative, intraoperative, and postoperative. Furthermore, a critical appraisal of existing predictive models is presented. The synthesis aims to offer a reference framework for the early identification of high-risk patients and the optimization of perioperative management in clinical practice.