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目的:分析原位肝移植（orthotopic liver transplantation, OLT）患者术后早期急性肾功能衰竭（acute renal failure, ARF）的发生率以及OLT术后发生ARF患者早期的病死率，并评估OLT术后ARF的预测因素。方法:回顾性分析三家临床医疗中心（首都医科大学附属北京朝阳医院，解放军总医院第三医学中心，首都医科大学附属北京佑安医院）2005年6月—2013年6月完成OLT的患者1 669例。根据术后是否发生ARF，将患者分为肾衰组（84例）和非肾衰组（1 585例）。分析两组患者一般情况、病死率及影响OLT术后ARF发生的危险因素。结果:1 669例OLT患者中84例术后早期发生ARF，发生率5%。51例（3%）患者住院期间死亡，其中肾衰组病死率（42.9%）大于非肾衰组（0.9% ）。单因素和多因素回归分析结果显示，术前合并肝肾综合征（95%CI 4.453~17.564，n P<0.05）、出血量多（95%CI 1.000，n P<0.05 ）、手术时间长（95%CI 1.004~1.189，n P< 0.05 ）、术后二次开腹止血（95%CI 1.330~4.972 ，n P<0.05 ）、术后肺部感染（95%CI 6.105~19.847 ，n P<0.05）是OLT术后并发ARF的危险因素。n 结论:OLT术后ARF患者病死率高，术前合并肝肾综合征、手术时间长、出血量多、术后二次开腹止血、术后肺部感染是OLT术后发生ARF的独立危险因素。“,”Objective:To analyze the incidence of acute renal failure (ARF), the mortality rate, and to assess the predictors of ARF after orthotopic liver transplantation (OLT).Methods:One thousand six hundred and sixty-nine liver OLT patients in three clinical medical centers (Beijing Chaoyang Hospital Affiliated to Capital Medical University, the Third Medical Center of Chinese PLA General Hospital, and Beijing Youan Hospital Affiliated to Capital Medical University) between June 2005 and June 2013 were investigated. Patients were divided into the renal failure group (84 cases) and the non-renal failure group (1 585 cases). The patients' clinical characteristics, mortality, and risk factors of ARF after OLT were analyzed.Results:Among the 1 669 OLT patients, 84 patients were diagnosed with ARF after surgery, with an incidence of 0.24%, and 51 patients died during hospitalization, with a mortality rate of 3%. The renal failure group's mortality rate was 42.9%, and 0.9% in the non-renal failure group. There was a significant difference between the two groups (n P<0.05). According to the Logistic regression, preoperative complications of liver and kidney syndrome (95%CI 4.453-17.564,n P<0.05), more blood loss (95%CI 1.000,n P<0.05), long operation time (95%CI 1.004-1.189,n P<0.05), postoperative hemostasis after the second laparotomy (95%CI 1.330-4.972,n P<0.05) and postoperative pulmonary infection (95%CI 6.105-19.847,n P< 0.05) were risk factors for ARF after OLT.n Conclusions:The renal failure group's mortality rate is significantly higher than that of the non-renal failure group. Hepatorenal syndrome preoperative, long operation time, blood loss, re-laparotomy for hemorrhage postoperative, and pulmonary infection were risk factors of ARF after OLT.