血压变异性, 肝移植, 急性肾损伤, 列线图模型

Objective To investigate the influencing factors of post-liver transplant acute kidney injury (post-LT AKI), and to analyze whether intraoperative hypotension and blood pressure variability affect the incidence of post-LT AKI. Methods Recipients who underwent liver transplantation under general anesthesia were selected between Jun. 1, 2013 and May 31, 2023, in Affiliated Jinling Hospital, Medical School of Nanjing University. The general clinical data and intraoperative blood pressure data of the recipients were collected, and the variability of mean arterial pressure (MAP) was assessed in 4 dimensions: standard deviation (SD), coefficient of variation (CV), average real variability (ARV), and variation independent of mean (VIM). Post-LT AKI influence factors were analyzed with univariate and multivariate Logistic regression, column-line plots were constructed with R software, and the predictive effect was assessed with receiver operating characteristic (ROC) curves. Results Post-LT AKI occurred in 162 of 437 subjects, with an incidence rate of 37.07%; the group was categorized into the AKI group (n=162) and the NO-AKI group (n=275) according to whether or not post-LT AKI occurred. Univariate analysis P<0.1 and previous studies noted as independent risk factors were included in multiple Logistic regression, which showed the following: diabetes [OR=2.141, 95%CI 1.267-3.616, P=0.004], ARV [OR=1.149, 95%CI 1.091-1.209, P<0.001], VIM [OR=2.430, 95%CI 1.303-4.533, P=0.005], the accumulative time of MAP less than 65 mmHg [OR=1.051, 95%CI 1.028-1.073, P<0.001], the accumulative area of MAP less than 65 mmHg [OR=1.008, 95%CI 1.004-1.012, P<0.001], and increased intraoperative blood loss [OR=1.017, 95%CI 1.002-1.032, P=0.029] were independent risk factors for post-LT AKI, and increased urinary output [OR=0.935, 95%CI 0.902-0.968, P<0.001] and use of terlipressin [OR=0.582, 95%CI 0.359-0.942, P=0.028] were protective factors for post-LT AKI. The nomogram model constructed with the above influence factors had an area under the ROC curve (AUC) of 0.833, which showed a good fit and consistency. Conclusion The accumulative time and accumulative area of MAP less than 65 mmHg, ARV, and VIM in liver transplantation is significantly associated with post-LT AKI. Perioperative hypotension should be avoided as much as possible and intraoperative hemodynamic stability should be maintained. Preoperative diabetes and increased intraoperative blood loss lead to an increased incidence of post-LT AKI. Increased urinary output, and the use of terlipressin have a certain renoprotective effect.

blood pressure variability, liver transplantation, acute kidney injury, nomogram model