title: [Analysis of independent risk factor in patients with poor prognosis after liver transplantation].
abstract: OBJECTIVE
  To investigate the prognosis after orthotopic liver transplantation (OLT), and to elucidate the risk factors of poor prognosis in these patients.
  
  
  METHODS
  Adult recipients of OLT in Renji Hospital of Shanghai Jiaotong University were retrospectively analyzed. Data in pre-, intra- and post-OLT periods of these patients were collected. Acute kidney injury net (AKIN) criteria were used to analyze the post-OLT acute kidney injury (AKI). By following up all the patients for over a year, Kaplan-Meier survival analysis was used to evaluate the prognosis within 28 days and 1 year. Cox regression analysis was performed to evaluate risk factors of patient death, especially the influence of AKI on patient prognosis.
  
  
  RESULTS
  There were 193 patients enrolled, the average age was (48.07+/-10.02) years old. The ratio of male to female was 4:1. One hundred and sixteen patients (60.1%) were found to have AKI after OLT. Twenty-eight-day mortality of post-OLT AKI patients was higher than that without AKI patients [15.5%(18/116) vs. 0, P<0.05], 1 year survival rate of post-OLT AKI patients was lower than that without AKI patients [(70.7% (82/116) vs. 90.9 (70/77), P<0.05). Kaplan-Meier survival analysis showed the survival rate of non-AKI (77 patients), AKI stage 1, 2 and 3 patients (58, 25 and 33 patients respectively) post-OLT were 90.9%, 81.0%, 84.0% and 42.4%, respectively. All the non-survivors were discovered to have AKI within 28 days post-OLT. Cox regression analysis showed pre-OLT hypertension [hazard ratio (HR)=4.398, 95% confidence interval (CI)ú 1.535-12.604, P=0.006], post-OLT AKI (HR=12.100, 95%CI: 1.565-93.540, P=0.017), infection (HR=4.709, 95%CI: 1.813-12.226, P=0.001) and acute physiology and chronic health evaluation II (APACHE II) score > or =10 (HR=3.627, 95%CI: 1.244-10.573, P=0.018) were risk factors of 1 year death.
  
  
  CONCLUSIONS
  AKI is an independent risk factor of poor prognosis after liver transplantation. Prevention of AKI may improve the survival rate of OLT patients.
authors.affiliation: Renal Division, Renji Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200127, China.
authors.forename: Ming-li
authors.initials: ML
authors.lastname: Zhu
authors.forename: Yi
authors.initials: Y
authors.lastname: Li
authors.forename: Jia-qi
authors.initials: JQ
authors.lastname: Qian
authors.forename: Qiang
authors.initials: Q
authors.lastname: Xia
authors.forename: Si-Yue
authors.initials: SY
authors.lastname: Wang
authors.forename: Ren-hua
authors.initials: RH
authors.lastname: Lu
authors.forename: Miao-lin
authors.initials: ML
authors.lastname: Che
authors.forename: Hui-li
authors.initials: HL
authors.lastname: Dai
authors.forename: Zhao-hui
authors.initials: ZH
authors.lastname: Ni
authors.forename: Yu-cheng
authors.initials: YC
authors.lastname: Yan
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D055815:Young Adult