[1]徐磊,张韬,周斌,等.肝移植后急性肾损伤围术期麻醉管理的研究进展[J].医学研究与战创伤救治(原医学研究生学报),2026,39(01):107-112.[doi:10.16571/j.cnki.2097-2768.2026.01.018]
　XU Lei,ZHANG Tao,ZHOU Bin,et al.Research progress on perioperative anesthesia management for acute kidney injury after liver transplantation[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2026,39(01):107-112.[doi:10.16571/j.cnki.2097-2768.2026.01.018]
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肝移植后急性肾损伤围术期麻醉管理的研究进展()

《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第39卷
期数:
2026年01期
页码:
107-112
栏目:
综述
出版日期:
2026-01-20

文章信息/Info

Title:
Research progress on perioperative anesthesia management for acute kidney injury after liver transplantation
作者:
徐磊; 张韬; 周斌; 段满林
东部战区总医院麻醉科，江苏南京 210002
Author(s):
XU Lei;  ZHANG Tao;  ZHOU Bin;  DUAN Manlin
（Department of Anesthesiology, General Hospital of Eastern Theater Command, PLA, Nanjing 210002, Jiangsu, China）
关键词:
急性肾损伤; 肝移植; 麻醉; 肾功能
Keywords:
acute kidney injury;  liver transplantation;  anesthesia;  renal function
分类号:
R692R657.3
DOI:
10.16571/j.cnki.2097-2768.2026.01.018
文献标志码:
A
摘要:
肝移植是挽救终末期肝病患者的革命性技术，近年来取得了重大进展，但肝移植后急性肾损伤（postLT AKI）仍有较高的发生率，对患者预后和死亡率有显著影响，增加了医疗成本。越来越多证据表明，麻醉管理是影响术后急性肾损伤（AKI）的重要因素之一。在肝移植术中，严重低血压、大出血、使用血管活性药物、大量输注红细胞、再灌注后综合征等被确定为postLT AKI的可改变危险因素。同样一些干预措施如合理使用改善肾功能的药物、严密的术中监测等手段可有效降低AKI的发生率。文章主要对肝移植术中不同阶段的血压管理、容量管理、肾保护性药物及术中特殊监测等方面进行综述，以期为研究postLT AKI的防治策略提供一些参考。
Abstract:
Liver transplantation is a revolutionary technology for rescuing patients with endstage liver disease, and significant progress has been made in recent years. However, acute kidney injury after liver transplantation (post LT AKI) still has a high incidence rate, which has a significant impact on patient prognosis and mortality, and increases medical costs. More and more evidence suggests that anesthesia management is one of the important factors affecting postoperative acute kidney injury (AKI). In liver transplantation, severe hypotension, hemorrhage, the use of vasoactive drugs, the massive transfusion of red blood cells, and postreperfusion syndrome have been identified as modifiable risk factors for post LT AKI. Similarly, the interventions such as the rational use of drugs to improve renal function and rigorous intraoperative monitoring can effectively reduce the incidence of AKI. The article mainly reviews the aspects of blood pressure management, volume management, renal protective drugs and special intraoperative monitoring at different stages of liver transplantation, aiming to provide references for the study of prevention and treatment strategies for post LT AKI.

参考文献/References:

[1]Fabrizi F, Donato MF, Cerutti R, et al. Acute kidney injury and chronic kidney disease after liver transplant: A retrospective observational study[J]. Nefrologia (Engl Ed), 2022, 42(1): 4149.[2]Zhou J, Zhang X, Lyu L, et al. Modifiable risk factors of acute kidney injury after liver transplantation: a systematic review and metaanalysis[J]. BMC Nephrol, 2021, 22(1): 149.[3]白明传, 毛慧娟. 肝移植术后急性肾损伤的研究新进展[J]. 临床肾脏病杂志, 2020, 20(12): 9961002.[4]Penev Y, Ruppert MM, Bilgili A, et al. Intraoperative hypotension and postoperative acute kidney injury: A systematic review[J]. Am J Surg, 2024, 232: 4553.[5]Mathis MR, Naik BI, Freundlich RE, et al. Preoperative Risk and the Association between Hypotension and Postoperative Acute Kidney Injury[J]. Anesthesiology, 2020, 132(3): 461475.[6]韩玉珍, 王延庆, 黄立锋. 肝移植术后早期肝功能不全危险因素及防治的研究进展[J]. 医学研究生学报, 2021, 34(2): 185189.[7]Tokodai K, Lannsj C, Kjaernet F, et al. Association of postreperfusion syndrome and ischemiareperfusion injury with acute kidney injury after liver transplantation[J]. Acta Anaesthesiol Scand, 2020, 64(6): 742750.[8]Jiang R, Ma H, Song X, et al. Increased intraabdominal pressure linked to worse longterm prognosis among patients with orthotopic liver transplantation: a retrospective, observational study[J]. BMC Gastroenterol, 2025, 25(1): 204.[9]Carrier FM, Girard M, Zuo RM, et al. Intraoperative Vasoactive Medications and Perioperative Outcomes in Liver Transplantation: A Systematic Review and Network Metaanalyses[J]. Transplantation, 2024, 108(4): 854873.[10]窦晓婧, 王清平, 翁亦齐, 等. 肝移植患儿术中血流动力学变化与急性肾损伤的相关性[J]. 临床麻醉学杂志, 2021, 37(4): 343347.[11]Roller J, Glanemann M. Keep the pressure! Correlation of hemodynamic instability after reperfusion and severity of acute kidney injury following liver transplantation[J]. Transpl Int, 2017, 30(7): 658659.[12]Manning MW, Kumar PA, Maheshwari K, et al. PostReperfusion Syndrome in Liver TransplantationAn Overview[J]. J Cardiothorac Vasc Anesth, 2020, 34(2): 501511.[13]Weinberg L, Broad J, Pillai P, et al. Sodium bicarbonate infusion in patients undergoing orthotopic liver transplantation: a single center randomized controlled pilot trial[J]. Clin Transplant, 2016, 30(5): 556565.[14]Lichtenegger P, Schiefer J, Graf A, et al. The association of preoperative anaemia with survival after orthotopic liver transplantation[J]. Anaesthesia, 2020, 75(4): 472478.[15]Adegboye J, Sapatnekar S, Mascha EJ, et al. Prolonged Blood Storage and Risk of Posttransfusion Acute Kidney Injury[J]. Anesthesiology, 2022, 136(1): 138147.[16]Wang Y, Li Q, Ma T, et al. Transfusion of Older Red Blood Cells Increases the Risk of Acute Kidney Injury After Orthotopic Liver Transplantation: A Propensity Score Analysis[J]. Anesth Analg, 2018, 127(1): 202209.[17]Najjar M, Sharma P. Perioperative acute kidney injury among liver transplant recipients: To albumin or not[J]. Liver Transpl, 2023, 29(8): 791792.[18]Wiedermann CJ, Wiedermann W, Joannidis M. Hypoalbuminemia and acute kidney injury: a metaanalysis of observational clinical studies[J]. Intensive Care Med, 2010, 36(10): 16571665.[19]Sang BH, Bang JY, Song JG, et al. Hypoalbuminemia Within Two Postoperative Days Is an Independent Risk Factor for Acute Kidney Injury Following Living Donor Liver Transplantation: A Propensity Score Analysis of 998 Consecutive Patients[J]. Crit Care Med, 2015, 43(12): 25522561.[20]Kim D, Kim J, Han S, et al. Effects of 20% albumin infusion therapy during liver transplantation on plasma neutrophil gelatinaseassociated lipocalin level: A randomized controlled trial[J]. Liver Transpl, 2023, 29(8): 861870.[21]Hand WR, Whiteley JR, Epperson TI, et al. Hydroxyethyl starch and acute kidney injury in orthotopic liver transplantation: a singlecenter retrospective review[J]. Anesth Analg, 2015, 120(3): 619626.[22]Duncan AE, Jia Y, Soltesz E, et al. Effect of 6% hydroxyethyl starch 130/0.4 on kidney and haemostatic function in cardiac surgical patients: a randomised controlled trial[J]. Anaesthesia, 2020, 75(9): 11801190.[23]Huang CJ, Cheng KW, Chen CL, et al. Clinical Beneficial Effects of Using Crystalloid only in Recipients of Living Donor Liver Transplantation[J]. Int J Environ Res Public Health, 2017, 14(11): 1418.[24]Oh HW, Lee JH, Kim HC, et al. The effect of 6% hydroxyethyl starch (130/0.4) on acute kidney injury in paediatric cardiac surgery: a prospective, randomised trial[J]. Anaesthesia, 2018, 73(2): 205215.[25]Chen Y, Ning X, Lu H, et al. Effects of hydroxyethyl starch and gelatin on the risk of acute kidney injury following orthotopic liver transplantation: A multicenter retrospective comparative clinical study[J]. Open Med (Wars), 2021, 16(1): 322331.[26]Morkane CM, Sapisochin G, Mukhtar AM, et al. Perioperative fluid management and outcomes in adult deceased donor liver transplantation—A systematic review of the literature and expert panel recommendations[J]. Clin Transplant, 2022, 36(10): e14651.[27]Zhang S, Ma J, An R, et al. Effect of cumulative fluid balance on acute kidney injury and patient outcomes after orthotopic liver transplantation: A retrospective cohort study[J]. Nephrology (Carlton), 2020, 25(9): 700707.[28]Jia D, Guo S, Wu X, et al. Effect of dexmedetomidine on liver transplantation: a metaanalysis[J]. Front Pharmacol, 2023, 14: 1188011.[29]Soh S, Shim JK, Song JW, et al. Effect of dexmedetomidine on acute kidney injury after aortic surgery: a singlecentre, placebocontrolled, randomised controlled trial[J]. Br J Anaesth, 2020, 124(4): 386394.[30]Cho JS, Shim JK, Soh S, et al. Perioperative dexmedetomidine reduces the incidence and severity of acute kidney injury following valvular heart surgery[J]. Kidney Int, 2016, 89(3): 693700.[31]李红霞, 翁亦齐, 喻文立, 等. 右美托咪定对亲体肝移植患儿肾损伤标志物和炎症因子的影响[J]. 广东医学, 2019, 40(9): 12821285.[32]Weinberg EM, Wong F, Vargas HE, et al. Decreased need for RRT in liver transplant recipients after pretransplant treatment of hepatorenal syndrometype 1 with terlipressin[J]. Liver Transpl, 2024, 30(4): 347355.[33]Moore K, Jamil K, Verleger K, et al. Realworld treatment patterns and outcomes using terlipressin in 203 patients with the hepatorenal syndrome[J]. Aliment Pharmacol Ther, 2020, 52(2): 351358.[34]Reddy MS, Kaliamoorthy I, Rajakumar A, et al. Doubleblind randomized controlled trial of the routine perioperative use of terlipressin in adult living donor liver transplantation[J]. Liver Transpl, 2017, 23(8): 10071014.[35]黑子清. 肝移植围术期器官损伤机制及器官保护策略研究进展[J]. 中山大学学报(医学版), 2019, 40(4): 487492.[36]Yoo S, Lee HJ, Lee H, et al. Association Between Perioperative Hyperglycemia or Glucose Variability and Postoperative Acute Kidney Injury After Liver Transplantation: A Retrospective Observational Study[J]. Anesth Analg, 2017, 124(1): 3541.[37]Wang YJ, Li JH, Guan Y, et al. Diabetes mellitus is a risk factor of acute kidney injury in liver transplantation patients[J]. Hepatobiliary Pancreat Dis Int, 2021, 20(3): 215221.[38]江方正, 王芳, 张双双, 等.肝移植患者术后血糖调控方案的构建及应用[J]. 医学研究与战创伤救治, 2024, 37(4): 375380.[39]Milder DA, Liang SS, Ong SG, et al. Association between intraoperative oliguria and postoperative acute kidney injury in noncardiac surgical patients: a systematic review and metaanalysis[J]. J Anesth, 2023, 37(2): 219233.[40]Silverton NA, Lofgren LR, Hall IE, et al. Noninvasive Urine Oxygen Monitoring and the Risk of Acute Kidney Injury in Cardiac Surgery[J]. Anesthesiology, 2021, 135(3): 406418.[41]Kim WH, Oh HW, Yang SM, et al. Intraoperative Hemodynamic Parameters and Acute Kidney Injury After Living Donor Liver Transplantation[J]. Transplantation, 2019, 103(9): 18771886.[42]比木赤布, 余佳, 王卫星. 肝移植术后早期急性肾损伤预测指标的研究进展[J]. 疑难病杂志, 2021, 20(2): 203206,211.[43]Lima C, de Paiva Haddad LB, de Melo PDV, et al. Early detection of acute kidney injury in the perioperative period of liver transplant with neutrophil gelatinaseassociated lipocalin[J]. BMC Nephrol, 2019, 20(1): 367.[44]Tajima S, Yamamoto N, Masuda S. Clinical prospects of biomarkers for the early detection and/or prediction of organ injury associated with pharmacotherapy[J]. Biochem Pharmacol, 2019, 170: 113664.[45]Lima C, Gorab DL, Fernandes CR, et al. Role of proenkephalin in the diagnosis of severe and subclinical acute kidney injury during the perioperative period of liver transplantation[J]. Pract Lab Med, 2022, 31: e00278.

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备注/Memo

备注/Memo:
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更新日期/Last Update: 2026-01-20