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Effect of cumulative fluid balance on acute kidney injury and patient outcomes after orthotopic liver transplantation: A retrospective cohort study
Author(s) -
Zhang Simei,
Ma Jiguang,
An Rui,
Liu Lin,
Li Jianpeng,
Fang Zeping,
Wang Qiang,
Ma Qingyong,
Shen Xin
Publication year - 2020
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.13702
Subject(s) - medicine , acute kidney injury , perioperative , odds ratio , retrospective cohort study , liver transplantation , complication , renal replacement therapy , confidence interval , univariate analysis , cohort , surgery , transplantation , multivariate analysis
Aim Acute kidney injury (AKI) is a serious complication following orthotopic liver transplantation (OLT) and it affects long‐term patient survival. The aims of this study were to identify the effects of cumulative fluid balance (FB) on early post‐OLT AKI and adverse outcomes and to construct a model to predict AKI. Methods We retrospectively analysed 146 adult patients who underwent OLT. AKI severity was classified according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Univariate and multivariate logistic regression analyses were used to evaluate the association between cumulative FB and post‐OLT AKI. The Kaplan‐Meier method was used to estimate the survival rate. Results Within the perioperative period of 72 hours, 50% (66/132) of patients developed AKI, with 36 (54%), 16 (24%) and 14 (21%) patients having AKI stages 1, 2 and 3, respectively. The cumulative FB was the risk factors for post‐OLT AKI (odds ratio [OR], 1.011; 95% confidence interval [CI], 1.156~6.001; P = .021). Preoperative albumin was a protective factor for post‐OLT AKI (OR, 0.309; 95% CI, 0.140~0.731; P = .007). The AKI group requires renal replacement therapy (RRT) more (15.2% vs 0%, P = .001) and associated with postoperative complications (56% vs 28.8%, P = .003). The complication‐free survival was lower in the AKI group ([11.90 vs 18.74] months, χ 2 = 9.60, P = .002). Conclusion Cumulative FB within 72 hours is associated with post‐OLT AKI and requires RRT. Cumulative FB impacts the long‐term complication‐free survival of the recipients.