Low intra-operative urine output is associated with the development of severe acute kidney injury and continuous renal replacement therapy requiring after liver transplantation
Yu Nie1, Jinbo Huang2,3,4, Shujiao He1, Huadi Chen2,3,4, Junjun Jia5, Qiang Zhao2,3,4, Xiaoshun He2,3,4.
1General Surgery Center, Zhujiang Hospital of Southern Medical University, Guangzhou, People's Republic of China; 2Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China; 3Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Sun Yat-sen University, Guangzhou, People's Republic of China; 4Guangdong Provincial International Cooperation Base of Science and Technology, Sun Yat-sen University, Guangzhou, People's Republic of China; 5Division of Hepatobiliary and Pancreatic Surgery, Prople's Hospital of Zhejiang Province, Hangzhou, People's Republic of China
Acute kidney injury (AKI) is associated with adverse outcomes after liver transplantation(LT). The impact of intraoperative urine output(UO) on post-LT AKI remains unclear. 660 consecutive LT patients between 01/2015–12/2020 were analyzed. The rates of non-AKI, AKI-I, severe AKI(AKI-II and -III) were 51.5%, 22.7% and 25.8%. 38.1% and 89.1% AKI cases were developed during operation or within 72h after LT. As AKI severity rose, the proportion of SAKI patients remarkably increased from 19.3% to 65.7% and creatinine maintained at significantly higher levels within one year. SAKI patients had inferior 90-day, 1- and 3-year survival compared with non-AKI and AKI-I patients (p<0.001). Low UO was independently associated with SAKI and continuous renal replacement therapy(p<0.001), with best cut-off of 1.84ml/kg/h(AUC 0.780) and 1.38 ml/kg/h(AUC 0.838). Low UO(<1.84ml/kg/h) was an independent risk factor for major adverse kidney events(OR 2.262, p=0.002), 90-day mortality(HR 3.795, p<0.001), and one-year mortality(HR 2.877, p<0.001). Patients experiencing both low UO and AKI had the worst 3-year patient survival compared with those having either low UO or AKI(p < 0.001). In conclusion, SAKI was mainly developed in operation. Intraoperative UO was a strong predictor for SAKI and should be carefully monitored to guide patient management and early intervention for renal dysfunction.
National Natural Science Foundation of China (81570587 and 81700557). Guangdong Provincial Key Laboratory Construction Projection on Organ Donation and Transplant Immunology (2013A061401007 and 2017B030314018). Guangdong Provincial Natural Science Funds for Major Basic Science Culture Project (2015A030308010). Guangdong Provincial Funds for High-end Medical Equipment (2020B1111140003). Science and Technology Program of Guangzhou (201704020150). Natural Science Foundations of Guangdong province (2016A030310141 and 2020A1515010091). Young Teachers Training Project of Sun Yat-Sen University (K0401068) . Colin New Star of Sun Yat-Sen University (R08027).
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