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The Risk Factors for Early Acute Renal Dysfunction after Orthotopic Liver Transplantation

Author: LiZiQiang
Tutor: ZuoYunJin
School: Shandong University
Course: General Surgery
Keywords: Liver transplantation Renal dysfunction Risk factor
CLC: R657.3
Type: Master's thesis
Year: 2008
Downloads: 28
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Abstract


Objective: To discuss the treatment and identify risk factors for early acute renal dysfunction (ARD)after orthotopic liver transplant-tation (OLT).Method: The clinical data of 68 OLT patients of shandong university affiliated qianfoshan hospital from2002-04 to 2007-12 were retrospectively analyzed to summarize the incidence rate of early ARD after OLT. The patients with early ARD after OLT were in group A,The others were in control group B.The modus operandi of the two groups is classical OLT without Veno-venous bypass used. Dopamine (2-3 ug/kg.min) was used from the beginning of the operation.The standard immune suppression plan(FK506+MP+MMF) was used after the operation. the suitable antibiotics was selected according to the biological culture,methods was used to keep the stabilization of blood-volume ,blood-pressure and blood-glucose. The stand of early ARF after OLT was to the patients with normal preoperative renal function, the chemical examination index that SCr≥132umol/L and (or)BUN≥18mmol/L after operation,and to the patients with abnormal preoperative renal function,the value of SCr and (or)BUN augment 50%.To record the correlated clinical and laboratory index including the age, preoperative glutamic pyruvic transaminase , preoperative hemoglobin, preoperative MELD value, preoperative serum creatinine and blood urea nitrogen values, operative duration, anhepatic phase and intraoperative transfusion, and Univariate analyses were performed to determine which were the relevant risk factors at the beginning after operation among the 9 factors.The difference among the groups of measurement data. was tested by t-test. The Intergroup difference has statistical significance. at the stand of P <0.05.Results: The incidence of acute ARD was 19.12%. The univariate analysis showed that the age, preoperative MELD value, preoperative serum creatinine and blood urea nitrogen values, operative duration, anhepatic phase and intraoperative transfusion were significantly different between the ARD group and non-ARD. The Intergroup difference has statistical significance. However, The Intergroup difference of preoperative glutamic pyruvic transaminase and hemoglobin have not statistical significance.Conclusion: Under normal circumstances, the kidney is a high blood flow and high oxygen capacity organ, which is sensitive of ischemia and hypoxia. Renal parenchyma will be damaged by ischemia and hypoxia when organism is in hypoperfusion by any reason. The etiopathogenesis of early acute renal dysfunction after orthotopic liver transplantation is multifactorial , including preoperative liver inadequacy, preoperative renal inadequacy , hypovolemia, long anhepatic phase and intraoperative transfusion. Getting the message of correlated risk factors of early acute renal dysfunction after orthotopic liver transplantation conduce to take directional precaution.

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CLC: > Medicine, health > Surgery > Of surgery > Abdominal surgery > Liver and liver tube
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