Risk factors of early acute kidney injury and continuous renal replacement therapy in patients undergoing orthotopic liver transplantation

Objective To study the risk factors of acute kidney injury(AKI) associated with liver transplantation and to analyze the safety and efficacy of continuous renal replacement therapy(CRRT) in these patients.Methods Totally 505 patients received orthotopic liver transplantation(OLT) in our hospital from January 2001 to September 2008,and 25 developed AKI and needed CRRT.The general condition,hepatic function,renal function,intraoperation urine output,operation time,blood loss,and fluid infusion were retrospectively analyzed and compared between the AKI group and control group(without AKI).The changes of electrolyte,renal function,coagulation function and hemodynamics were observed in AKI group before and after CRRT treatment.Results The hemoglobin and albumin were similar between the two groups.Eight patients died and the mortality was 32.0%.The pre-transplantation serum creatinine(SCr) and total bilirubin(STB) in AKI group were significantly higher and the prothrombin activity was significantly lower than those of the control group(P0.05).The unhepatic time periods were similar between the two groups.The total operation time,intraoperative blood loss,intraoperative blood transfusion,total intraoperative fluid transfusion in the AKI group were significantly higher than those of the control group(P0.05);intraoperative urine output was significantly lower than that of the control group(P0.05).The SCr,BUN,and K levels and PLT count were significantly decreased after treatment(P0.05).There were no significant differences in PT,APTT,and FI before and after treatment.The CVP,MPAP,and PAWP were significantly decreased after treatment(P0.05).The MAP values were similar before and after treatment.Conclusion CRRT is safe and effective in treatment of liver transplantation associated AKI.When there are risks for AKI,renal supporting treatments should be given to the patients to rapidly decrease the volume loading,maintain the stability of internal environment.