An effective model for predicting acute kidney injury after liver transplantation.
BACKGROUND
Acute kidney injury (AKI) is a common complication in the early period after liver transplantation (LT), posing an enormous obstacle to treatment efficiency and patient survival. However, the exact influencing factors of AKI are still unclear and a predictive model is desperately required in the clinic.


METHODS
Data of 102 consecutive LTs were reviewed. A model for predicting AKI was established and further validated in a prospective study of 44 patients receiving LT.


RESULTS
The incidence of AKI was 32.4%. AKI patients showed a significantly lower survival rate than non-AKI patients. Multivariate analysis demonstrated the independent influencing factors of AKI were preoperative serum creatinine >1.2 mg/dl, intraoperative urine output <or=60 ml/h, intraoperative hypotension status, and intraoperative use of noradrenaline. A model was then established and showed a sensitivity of 75.0%, a specificity of 93.8%, and an accuracy of 88.6% in predicting AKI.


CONCLUSIONS
High preoperative serum creatinine, low intraoperative urine output, and intraoperative hypotension contribute to the development of AKI, and intraoperative use of noradrenaline serves as a protective factor. The predictive model could potentially facilitate early prediction and surveillance of AKI.
Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Xiao
X
Xu
Qi
Q
Ling
Qiang
Q
Wei
Jian
J
Wu
Feng
F
Gao
Zeng-Lei
ZL
He
Lin
L
Zhou
Shu-Sen
SS
Zheng
D000208:Acute Disease; D000328:Adult; D015415:Biomarkers / Q000097:blood; D002681:China; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007022:Hypotension / Q000150:complications; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000209:etiology* / Q000401:mortality; D008107:Liver Diseases / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009638:Norepinephrine / Q000627:therapeutic use; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013997:Time Factors; D016896:Treatment Outcome; D014563:Urodynamics
D015415:Biomarkers; D003404:Creatinine; D009638:Norepinephrine