成人原位肝移植术后出现急性肾损伤的危险因素分析

Analysis of Risk Factors for Acute Kidney Injury after Adult Orthotopic Liver Transplantation

摘要: 目的：分析成人经典原位肝移植术后发生急性肾损伤(acute kidney injury)的情况和相关独立危险因素。方法：本研究采用回顾性分析的方法，收集了自2021年11月至2025年8月期间在安徽医科大学第二附属医院初次接受经典术式的成人原位肝移植患者的病例数据。参照2012年改善全球肾脏病预后组织(KDIGO)的临床指南标准来判定术后急性肾损伤(AKI)，并据此对比AKI与非AKI患者在术前、术中以及术后各项临床指标上的差异。首先通过单因素分析筛选出可能有关的危险因素，然后进一步运用Logistic多因素回归分析确定术后AKI的独立危险因素。结果：共纳入55例患者，有31例(56.4%)患者术后出现AKI。单因素分析的相关结果显示：AKI组与非AKI组患者间具有统计学意义的指标有：高血压、糖尿病、供肝脂肪变性程度、术中出血量、术中尿量、ICU入住时间、术后呼吸支持时间(P < 0.05)。多因素分析后结果提示：肝移植手术后发生AKI的独立危险因素如下：糖尿病[OR = 0.054, 95%CI (0.004, 0.688), P = 0.025]；供肝脂肪变性程度[OR = 6.719, 95%CI (1.233, 36.614), P = 0.028]；术中出血量[OR = 1.003, 95%CI (1.000, 1.006), P = 0.036]；术中尿量[OR = 0.998, 95%CI (0.997, 1.000), P = 0.018]。结论：基于本研究结果，肝移植受者术中少尿、大量失血、供肝中重度脂肪变性以及合并糖尿病被确认为术后发生急性肾损伤(AKI)的独立危险因素。因此，在围手术期实施针对性干预措施：包括精细化管理术中失血量与尿量、有效调控血糖水平，以及优先选用无或轻度脂肪变性的供肝，这些都将有助于降低术后AKI发生的风险，并对改善患者整体预后具有积极意义。

Abstract: Objective: To analyze the occurrence of acute kidney injury and related independent risk factors after classical in situ liver transplantation in adults. Methods: This study used retrospective analysis to collect case data from patients who received classical liver transplantation for the first time in the Second Affiliated Hospital of Anhui Medical University from November 2021 to August 2025. Refer to the clinical guidelines for improving the global prognostic tissue of kidney disease (KDIGO) in 2012 to determine postoperative acute kidney injury (AKI), and compare the differences in preoperative, intraoperative and postoperative clinical indicators of AKI and non-AKI patients accordingly. First, filter out the possible risk factors through single-factor analysis, and then further use Logistic multi-factor regression analysis to determine the independent risk factors of postoperative AKI. Results: A total of 55 patients were included, and 31 (56.4%) of them had AKI after surgery. The relevant results of single-factor analysis show that the statistically significant indicators between patients in the AKI group and the non-AKI group are hypertension, diabetes, the degree of fatty degeneration of the liver supply, intraoperative bleeding, intraoperative urine output, ICU stay time, and postoperative respiratory support time (P < 0.05). After multi-factor analysis, the results suggest that the independent risk factors for AKI after liver transplantation are as follows: diabetes [OR = 0.054, 95%CI (0.004, 0.688), P = 0.025]; the degree of fatty degeneration of the liver [OR = 6.719, 95%CI (1.233, 36.614), P = 0.028]; intraoperative bleeding [OR = 1.003, 95%CI (1.000, 1.006), P = 0.036]; intraoperative urine [OR = 0.998, 95%CI (0.997, 1.000), P = 0. 018]. Conclusion: Based on the results of this study, liver transplant recipients are identified as independent risk factors for postoperative acute kidney injury (AKI) due to oliguria, massive blood loss, severe lipoly lipother in liver transplant recipients. Therefore, the implementation of targeted interventions in the perioperative period: including the fine management of blood loss and urine during the operation, the effective regulation of blood sugar levels, and the priority of liver without or mild fatty degeneration will help reduce the risk of postoperative AKI and have positive significance for improving the overall prognosis of patients.