Risk factors of acute kidney injury in children with biliary atresia after living-donor liver transplantation

Q4 Medicine

中华小儿外科杂志 Pub Date : 2019-11-15 DOI:10.3760/CMA.J.ISSN.0253-3006.2019.11.010

Wu Man, Yu Wenli, Zhang Xinyue, Sheng Mingwei, Z. Nan, Ding Yijie, Du Hongyin

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Abstract

Objective To explore the occurrence and risk factors of acute kidney injury (AKI) after liver transplantation in children with biliary atresia (BA). Methods From June 2012 to October 2015, the clinical data were retrospectively reviewed for 198 pediatric living-donor liver transplant recipients with BA at Central Municipal Hospital.AKI was defined and staged according to the guidelines of Kidney Disease Improving Global Outcomes (KDIGO). The clinical data were compared for AKI versus non-AKI children using logistic regression analysis of the relevant factors of postoperative AKI.Chi-square test was performed for comparing the mortality rate during hospitalization between two groups. Results AKI occurred in 83 patients (41.92%) after liver transplantation.The stages of AKI were Ⅰ (n=47, 23.74%), Ⅱ (n=16, 8.08%) and Ⅲ (n=20, 10.10%). Multivariate logistic regression analysis indicated that intraoperative infusion of fresh frozen plasma was a risk factor for postoperative AKI.And preoperative high estimated glomerular filtration rate (eGFR), low serum creatinine (sCr) and high preoperative pediatric end-stage liver disease (PELD) score were independent risk factors for postoperative AKI.The in-hospital mortality rate of AKI group was significantly higher than that of non-AKI group(7.2% vs. 0.8%) and the mortality rate increased gradually with an aggravation of renal injury(P=0.027). Conclusions The incidence of AKI in BA children is 41.93% after liver transplantation.The patients with lower serum creatinine and higher PELD score have a higher risk of AKI.High PELD score may predict the occurrence of postoperative AKI and provide a reference for the risk of postoperative AKI mortality.It plays an important role in reducing the occurrence of AKI, lowering the mortality rate and improving the prognosis. Key words: Liver transplantation; Biliary atresia; Acute kidney injury; Child

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活体肝移植术后胆道闭锁患儿急性肾损伤的危险因素分析

目的探讨胆道闭锁(BA)患儿肝移植术后急性肾损伤(AKI)的发生及危险因素。方法回顾性分析2012年6月至2015年10月中心市立医院198例BA患儿活体肝移植的临床资料。AKI是根据肾脏疾病改善全球预后(KDIGO)指南定义和分期的。通过对术后AKI相关因素的logistic回归分析，比较AKI与非AKI患儿的临床数据。两组患者住院期间死亡率比较采用卡方检验。结果肝移植术后发生AKI 83例(41.92%)。AKI分期分别为Ⅰ(n=47, 23.74%)、Ⅱ(n=16, 8.08%)和Ⅲ(n=20, 10.10%)。多因素logistic回归分析显示术中输注新鲜冷冻血浆是术后AKI发生的危险因素。术前高肾小球滤过率(eGFR)、低血清肌酐(sCr)和高术前儿童终末期肝病(PELD)评分是术后AKI的独立危险因素。AKI组住院死亡率显著高于非AKI组(7.2% vs. 0.8%)，且随肾损伤加重住院死亡率逐渐升高(P=0.027)。结论BA患儿肝移植术后AKI发生率为41.93%。血清肌酐较低、PELD评分较高的患者发生AKI的风险较高。较高的PELD评分可以预测术后AKI的发生，并为AKI术后死亡率风险提供参考。它对减少AKI的发生、降低死亡率、改善预后具有重要作用。关键词:肝移植;胆道闭锁;急性肾损伤;孩子

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来源期刊

中华小儿外科杂志 Medicine-Pediatrics, Perinatology and Child Health

CiteScore

0.40

自引率

0.00%

发文量

8707

期刊介绍： Chinese Journal of Pediatric Surgery is an academic journal sponsored by the Chinese Medical Association. It mainly publishes original research papers, reviews and comments in this field. The journal was founded in 1980 and is included in well-known databases such as Peking University Journal (Chinese Journal of Humanities and Social Sciences) and CSCD Chinese Science Citation Database Source Journal (including extended version). It is one of the national key academic journals under the supervision of the China Association for Science and Technology. Chinese Journal of Pediatric Surgery enjoys a high reputation and influence in the academic community. The articles published in this journal have a high academic level and practical value, providing readers with a large number of practical cases and industry information, and have received widespread attention and citations from readers.