Background

Diabetes mellitus has become an increasing global health burden with rapid growing prevalence. Patients with diabetes have higher susceptibility to acute kidney injury (AKI). Liver transplantation (LT) predisposes the kidney to injury. However, the association between diabetes and AKI in LT patients remains unclear.

Methods

We conducted a retrospective cohort study examining risk factors for AKI in patients undergone orthotopic LT. Potential risk factors including baseline estimated glomerular filtration rate (eGFR), the model for end-stage liver disease (MELD) score, diabetes, hypertension and intraoperative blood loss were screened. The primary endpoint was AKI occurrence. Multivariate logistic regression was used to analyze the association between potential risk factors and AKI.

Results

A total of 291 patients undergone orthotopic LT were included in the present study. Among them, 102 patients (35.05%) developed AKI within 5 days after LT. Diabetes was identified as an independent risk factor for AKI. Patients who developed AKI had worse graft function recovery and higher mortality within 14 days after LT compared to those who did not develop AKI. AKI patients with diabetes had a significant decline of eGFR within the first postoperative year, compared with patients who did not develop AKI and who developed AKI but without diabetes.

Conclusions

Diabetes is an independent risk factor for AKI after orthotopic LT. AKI is associated with delayed graft function recovery and higher mortality in short-term postoperative period. Diabetic patients who developed AKI after LT experience a faster decline of eGFR within the first year after surgery.

中文翻译：

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糖尿病是肝移植患者急性肾损伤的危险因素

背景

糖尿病已成为日益严重的全球健康负担，患病率迅速增长。糖尿病患者更容易发生急性肾损伤（AKI）。肝移植 (LT) 使肾脏易受伤。然而，LT 患者中糖尿病与 AKI 之间的关联仍不清楚。

方法

我们进行了一项回顾性队列研究，检查接受原位 LT 的患者发生 AKI 的危险因素。筛查了包括基线估计肾小球滤过率（eGFR）、终末期肝病模型（MELD）评分、糖尿病、高血压和术中失血在内的潜在危险因素。主要终点是 AKI 的发生。采用多因素逻辑回归分析潜在危险因素与 AKI 之间的关联。

结果

本研究共纳入 291 名接受原位 LT 的患者。其中，102 例（35.05%）患者在 LT 后 5 天内发生 AKI。糖尿病被确定为 AKI 的独立危险因素。与未发生 AKI 的患者相比，发生 AKI 的患者在 LT 后 14 天内移植物功能恢复更差，死亡率更高。与未发生 AKI 和发生 AKI 但未发生糖尿病的患者相比，合并糖尿病的 AKI 患者在术后第一年的 eGFR 显着下降。

结论

糖尿病是原位 LT 后 AKI 的独立危险因素。AKI 与移植物功能恢复延迟和术后短期死亡率较高有关。LT 后发生 AKI 的糖尿病患者在术后第一年内 eGFR 下降更快。