Abstract:

Objective To investigate the kinetic changes of myoglobin（Mb）levels in serum and evaluate its prognostic implication in patients who received liver transplantation and suffered from new acute renal injury （AKI）. Methods A total of 191 hospitalized patients after liver transplantation from July 2018 to June 2020 were recruited in this retrospective study.（1）The important clinical indexes related to liver and kidney function and related score results were recorded before，during and after operation；（2）Serum Mb levels of patients were deter⁃ mined on post⁃operation hrs 0，24，48，72，respectively；（3）These patients were divided into AKI group（n = 80） and non ⁃AKI group（n = 111）according to the clinical outcomes at 72h after operation. Data were processed by Student′s t⁃test，analysis of variance of repeated measurement design and χ2 ⁃test. Logistic regression was used to screen out risk factors related to AKI. The validity of predicting patients′ AKI within the 72 h period with some selected variables was verified by receiver operating characteristic （ROC）curves. Results （1）Among these patients，the mean levels of serum Mb in AKI group were significantly higher than those in non⁃AKI group on post operation hrs 0，24，48，and 72（P < 0.001）；（2）Logistic regression analysis showed that the level of preoperative MELD score（OR = 1.083，95%CI：1.022 ~ 1.147，P = 0.007），intraoperative amount of bleeding（OR = 1.001， 95%CI：1.000 ~ 1.002，P = 0.003），intraoperative total fluid output（OR = 1.015，95%CI：1.010 ~ 1.032，P = 0.008） and serum Mb level at 72 h after operation（OR = 1.038，95%CI：1.026 ~ 1.050，P < 0.001）were the independent risk factors related to AKI outcome in patients；（3）The total areas under ROC curve of preoperative MELD score， intraoperative amount of bleeding，intraoperative total fluid output andserum Mb level at 72 h after operation for predicting AKI for 80 patients with liver transplantation were respectively 0.655（95%CI：3.55 ~ 15.84，P < 0.01， 0.672），（95% CI：4.83 ~ 17.17，P < 0.01），0.532（95%CI：2.52 ~ 12.88，P < 0.01），0.861（95%CI：5.17 ~ 19.42， P < 0.01）. The optimal threshold values were respectively 16.7 points，0.8 L，2.9 L，150 ng/mL. The sensitivities were respectively 58% ，56% ，46% ，84% ，and the specificities were respectively 69% ，70% ，69% ，82%. Conclusion The increase ⁃ inserum Mb levels in liver transplantation patients are significantly correlated with their AKI outcome. Monitoring the dynamic changes inserum Mblevels during the early stage may be useful to predict the outcome of liver transplantation patients with new renal complications.

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