孟繁秀　徐钧

[摘要] 肝移植术后急性肾功能损伤（acute kidney injury，AKI）是术后常见并发症之一，与术后死亡率的增加及术后慢性肾功能衰竭的发生密切相关。长期以来我们对肝移植术后AKI的认识始终模糊不清，主要是因为尚无被广泛接受的定义，而针对终末期肝病的患者，一些常用于评价肾脏功能的指标均有其局限性，这使得对术后AKI的早期发现、早期处理变得很困难。根据国内外许多中心的研究，导致肝移植术后AKI的因素是复杂的、多方面的。如何有效地预防、及时正确地诊断和处理此严重并发症已成为肝移植界的重要挑战。

[关键词] 肝移植术；急性肾损伤；并发症；危险因素

[中图分类号] R657.3 [文献标识码] A [文章编号] 1673-9701（2018）01-0159-06

Research status of early acute renal injury after liver transplantation

MENG Fanxiu1 XU Jun2

1.Graduate School， Shanxi Medical University， Taiyuan 030001， China； 2.Department of General Surgery， Shanxi Tumor Hospital， Taiyuan 030013， China

[Abstract] Acute kidney injury（AKI） after liver transplantation is one of the common complications after operation. It is closely related to the increase of postoperative mortality and the occurrence of postoperative chronic renal failure. For a long time our understanding of AKI after liver transplantation has always been vague， and this is mainly because there is no widely accepted definition. For patients with end-stage liver disease， some of the indicators commonly used to evaluate renal function have their limitations. This makes the early detection and early treatment of postoperative AKI become very difficult. According to the studies at many centers at home and abroad， the factors that lead to AKI after liver transplantation are complicated and multifaceted. How to effectively prevent and diagnose this serious complication in time and correctly has become an important challenge in the field of liver transplantation.

[Key words] Liver transplantation； Acute renal injury； Complications； Risk factors

因手术技术、器官保存技术的不断改进，围术期管理水平的提高，肝移植患者术后总体1年生存率可达86%，术后5年生存率提高到70%[1]，但术后各种急、慢性并发症仍是影响长期预后的主要因素。其中，肝移植术后急性肾功能损伤（acute kidney injury，AKI）是术后常见并发症之一，因诊断标准的不同，各中心报道的发病率在17%～95%[2，3]，肝移植术后AKI与死亡率的增加[4，5]与术后慢性肾功能衰竭[6]的发生密切相关。有文献报道，肝移植术后未并发AKI的患者28 d和1年死亡率分别是0%和3.9%，而肝移植术后并发AKI的患者死亡率增加到15.5%和25.9%[7]。甚至有文献报道，肝移植术后并发AKI的患者30 d死亡率高达50%，若需行肾脏替代治疗，死亡率达90%[8，9]。本文从肝移植受体肾功能的评估及AKI的诊断及其引起肝移植术后AKI的危险因素方面对此严重的并发症进行讨论，旨在提高对术后AKI的认识，加强围手术期管理，进而改善患者的短期及长期预后。……