Abstract: Objective To investigate the risk factors of hyperuricemia after liver transplantation
and provide recommendations for preventing hyperuricemia after liver transplantation.
Methods Total of 164 liver transplant recipients in Nanjing Drum Tower Hospital, the
Affliated Hospital of Nanjing University Medical School from January 2018 to May 2019
were retrospectively analyzed. The demographic and biochemical data, including gender, age,
body mass index, preoperative blood uric acid, duration of liver transplantation operation,
intraoperative blood loss, intraoperative urine volume, blood uric acid, average whole blood
trough concentration of tacrolimus in the frst week after surgery, variation of tacrolimus
whole blood trough concentration and creatinine clearance rate (CCr) in the frst week,1 month,
3 months and 6 months after transplantation were collected. According to the serum uric acid
level of 6 months after liver transplantation, the patients were divided into normal group and
hyperuricemia group. Multivariate Logistic regression was used to analyze the influencing
factors of hyperuricemia in liver transplant recipients. Results A total of 81 patients were
eventually enrolled and the incidence of hyperuricemia at 6 months after liver transplantation
was 48.15% (39/81). The proportion of male in hyperuricemia group was signifcantly higher
than that in normal group [84.62% (33/39) vs 64.28% (27/42); χ2 = 4.35, P = 0.04]. Renal
filtration function of patients in hyperuricemia group were significantly lower than those
in normal group [1 week after operation CCr: 93.67 ml/min vs 135.05 ml/min, 1 month after
operation CCr1: (105.39 ± 40.86) ml/min vs (127.54 ± 55.04) ml/min, 6 month after operation
CCr6: 82.64 ml/min vs 99.34 ml/min; all P ＜ 0.05]. Logistic regression showed that the
risk factors of hyperuricemia for liver transplantation recipients were intraoperative volume
of urine (OR = 1.001, 95%CI: 1.0002～1.0018, P = 0.0176) and mean trough concentration
of tacrolimus 1 week after liver transplantation (OR = 1.4158, 95%CI: 1.0256～1.9546, P =
0.0346), female (OR = 0.1936, 95%CI: 0.0368～0.8212, P = 0.0482) and creatinine clearance
at the 6 months after liver transplantation (OR = 0.9059, 95%CI: 0.8461～0.9698, P = 0.0045)
were protective factors. For female liver transplant recipients, the mean trough concentration of
tacrolimus of patients in hyperuricemia group was signifcantly higher than that in normal group at
1 week [(9.51 ± 2.42) ng/ml vs (6.34 ± 2.30) ng/ml; P ＜ 0.05]. For male liver transplant recipients,
CCr6 of patients in hyperuricemia group was significantly lower than those in normal group
(82.64 ml/min vs 115.34 ml/min; P ＜ 0.05). Logistic regression showed that for female
liver transplant recipients, the mean trough concentration of tacrolimus 1 week after liver
transplantation was an independent risk factor for hyperuricemia (OR = 1.83, 95%CI: 1.02～3.29,
P = 0.04). For male liver transplant recipients, intraoperative urine volume was an independent
risk factor for hyperuricemia (OR = 1.00, 95%CI: 1.00～1.00, P = 0.03) and CCr6 was a
protective factor (OR = 1.00, 95%CI: 1.00～1.00, P = 0.03). The incidence of hyperuricemia
in female patients with M ≥ 7.1 ng/ml was signifcantly higher than that with M ＜ 7.1 ng/ml
[66.67% (4/6) vs 13.33% (2/15), P = 0.03]. Conclusions Precision ?uid management to avoid
acute kidney injury caused by excessive output and maintaining M ＜ 7.1 ng/ml in female liver
transplantation recipients may help to reduce the incidence of hyperuricemia and improve the
survival rate and quality of life of liver transplantation recipients.