肝移植术后急性肾损伤的诊断与治疗

蔡金贞; 李志强; 许传屾; 赵凯; 戴德淑; 王新

doi:10.3969/j.issn.1674-7445.2023.04.001

肝移植术后急性肾损伤的诊断与治疗

doi: 10.3969/j.issn.1674-7445.2023.04.001

266000 青岛，青岛大学附属医院器官移植中心

基金项目:

山东省自然科学基金 ZR2022MH292

山东省学校卫生协会2022年度科研课题 SDWS2022070

青岛大学医学部“临床医学+X”工程科研项目 2017225

青岛大学附属医院“临床医学+X”科研项目 QYFY+X202101060

详细信息

作者简介:

通讯作者:
蔡金贞（ORCID：0000-0001-5414-1050），Email：caijinzhen@sina.comCai

中图分类号: R617, R692
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- 被引次数: 0
出版历程
- 收稿日期: 2023-04-30
- 网络出版日期: 2023-07-13
- 刊出日期: 2023-07-15

Diagnosis and treatment of acute kidney injury after liver transplantation

Organ Transplant Center of the Affiliated Hospital of Qingdao University, Qingdao 266000, China

More Information

Corresponding author: Jinzhen, Email: caijinzhen@sina.comCai

摘要

摘要: 急性肾损伤是肝移植术后常见的并发症，严重影响肝移植受者的预后。肝移植术前、术中和术后的多种因素均可引起肾损伤，如未进行妥善处理，可进展为慢性肾病，显著增加术后病死率，对肝移植的临床疗效产生负面影响。因此，肝移植术后急性肾损伤的预防、诊断及治疗是临床医师研究的热点。本文从急性肾损伤的定义，肝移植术后急性肾损伤的诊断、危险因素、预防及处理等几个方面进行综述，探讨肝移植术后急性肾损伤发生发展的各个阶段可能存在的危险因素及相关治疗策略，旨在通过优化治疗方案，降低肝移植术后急性肾损伤的风险，进一步改善肝移植受者的临床预后。
- 肝移植 /
- 急性肾损伤 /
- 慢性肾病 /
- 血清肌酐 /
- 肾小球滤过率 /
- 免疫抑制药 /
- 持续性肾脏替代治疗 /
- 缺血-再灌注损伤
Abstract: Acute kidney injury is a common complication after liver transplantation, which severely affects clinical prognosis of liver transplant recipients. Multiple factors before, during and after liver transplantation may cause kidney injury. If not properly treated, it may progress into chronic kidney diseases, which significantly increases postoperative fatality and negatively affects clinical efficacy of liver transplantation. Therefore, prevention, diagnosis and treatment of acute kidney injury after liver transplantation is a hot topic for clinicians. In this article, the definition, diagnosis, risk factors, prevention and treatment of acute kidney injury after liver transplantation were reviewed, and potential risk factors and related therapeutic strategies during different stages of acute kidney injury after liver transplantation were analyzed, aiming to lower the risk of acute kidney injury after liver transplantation and further improve clinical prognosis of liver transplant recipients by optimizing treatment regimens.
- Liver transplantation /
- Acute kidney injury /
- Chronic kidney disease /
- Serum creatinine /
- Glomerular filtration rate /
- Immunosuppressant /
- Continuous renal replacement therapy /
- Ischemia-reperfusion injury

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表 1 根据KDIGO定义的AKI分级

Table 1. Staging criteria of AKI defined by KDIGO

AKI分级	标准
1级	Scr≥1.5倍基线值或任意48 h内升高0.3 mg/dL^①，或尿量 < 0.5 mL/kg持续6~12 h
2级	Scr≥2倍基线值或尿量 < 0.5 mL/kg持续超过12 h
3级	Scr≥3倍基线值或增加至4.0 mg/dL或行紧急透析，或尿量 < 0.3 mL/kg持续超过24 h
注：①1 mg/dL=88.4 μmol/L。

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