Relationship between intra-abdominal hypertension and acute renal failure after liver transplantation

Objective To investigate the relationship between intra-abdominal hypertension (IAH) and acute renal failure (ARF) after liver transplantation.Methods The clinical data of 62 cases of liver transplantation were retrospectively analyzed. Intra-abdominal pressure was indirectly measured by intravesical pressure method. On the first 3 days after operation, intra-abdominal pressure over 20 mm Hg every day was regarded as IAH. Post-operative intra-abdominal pressure, serum creatinine and urea nitrogen levels, urine volume per h, glomerulus filtration gradient (GFG) and mean arterial pressure on the first 3 days after surgery were recorded. By using bivariable correlations and logistic regression analysis, the perioperative risk factors for ARF were analyzed.Results In IAH group (24 patients), in 11 cases ( 45.8 %) of ARF, GFG and urine volume per h were significantly lower, serum creatinine and urea nitrogen levels were significant higher than in No-IAH group on the first 3 days after operation. In No-IAH group (38 patients), ARF occurred in only 3 cases ( 7.9 %) with the difference being significant between two groups (P 0.05). Bivariable correlation analysis revealed that ARF was significantly correlated with age (older than 60 years), intraoperative blood transfusion volume (more than 3000 ml), decrease of intraoperative mean arterial pressure and post- operative IAH, postoperative sepsis, postoperative acute lung injury. Logistic and step wise regression analysis suggested that intraoperative blood transfusion volume (more than 3000 ml), decrease of intraoperative mean arterial pressure and postoperative IAH were independent risk factors for ARF.Conclusion IAH impaired renal function and was an independent risk factor for ARF after liver transplantation. It is worth monitoring intra-abdominal pressure in those subjects.