간 이식술 후 발생한 급성 신부전에 대한 위험인자 분석

Abstract

Purpose: Acute renal failure (ARF) is one of the common complications after liver transplantation (LT) and could be fatal unless promptly treated. Identification of risk factors is needed to prevent ARF and to attenuate the unfavorable outcomes of ARF after LT. The aim of this study was to analyze risk factors for development of postoperative ARF (between day 0 and day 30 after LT).

Methods: Total 72 LTs were performed between 1996 and 2005. Sixty six patients’ records, excluding 6 patients with preoperative serum creatinine level more than 2.5 mg/dl, were reviewed retrospectively for preoperative, intraoperative, and postoperative variables to compare patients presenting ARF with the remaining patients.

Results: Postoperative ARF occurred in 36 transplants (54.5%) after LT. Preoperative serum sodium, bilirubin and BUN, creatinine level were higher in ARF group. ARF group had more child-pugh class C, and more episodes of preoperative hepatic encephalopathy. During intraoperative period, anhepatic time was longer and total doses of intraoperative furosemide was larger in ARF group. Also, postoperative blood immunosuppressant level was higher, and postoperative episodes of bleeding and hypotension were more common in ARF group. In multivariate analysis, preoperative child-pugh class C (P=0.041), preoperative serum creatinine level (> or =1.0 mg/dL, P=0.032), and postoperative episodes of hypotension and bleeding (P=0.045, P=0.03 respectively) were identified as risk factors for postoperative ARF.

Conclusion: This study showed that preoperative renal and liver function, and postoperative hemodynamic condition were independent risk factors for development of ARF after LT.