Preditores de injúria renal aguda em pacientes submetidos ao transplante ortotópico de fígado convencional sem desvio venovenoso

Abstract

-Background -Acute kidney injury is one of the most common complications of orthotopic liver transplantation. The absence of universal criteria for definition of these conditions make comparisons difficult between studies. The conventional technique for transplantation is the total excision of the inferior vena cava during liver retro-native hepatectomy. Controversies about the effect of the conventional technique without venovenous bypass on renal function remain. Aim -To estimate the incidence and risk of acute kidney injury factors among recipients of orthotopic liver transplantation without conventional venovenous bypass. Methods -Was studied 375 patients undergoing orthotopic liver transplantation. Variables were analyzed in preoperative, intraoperative and postoperative complications in 153 patients undergoing orthotopic liver transplantation without conventional venovenous bypass. The criterion for acute kidney injury was serum creatinine ≥ 1.5 mg/dl or urinary debit <500 ml/24h within the first three days post-transplant. Univariate analysis and multivariate logistic regression were done. Results -All transplants were performed with grafts from deceased donors. Sixty patients (39.2%) had acute kidney injury. Age, body mass index, ChildTurcotte-Pugh, urea, hypertension, and preoperative serum creatinine were higher in the acute kidney injury group. During the intraoperative period, the group acute kidney injury had more reperfusion syndrome, transfusion of red blood cells, fresh frozen plasma and platelets. Postoperatively, the duration of mechanical ventilation and postoperative creatinine levels were also variable, with significant differences for the group of acute kidney injury. After logistic regression, the reperfusion syndrome, the class C of the Child-Turcotte-Pugh and postoperative serum creatinine showed differences. Conclusion -Acute kidney injury after orthotopic liver transplantation without conventional venovenous bypass is a common disorder, but with good prognosis. Reperfusion syndrome, serum creatinine postoperatively and Child C are factors associated with acute kidney injury after orthotopic liver transplantation without conventional venovenous bypass. ABCDDV/781RESUMO -Racional -Injúria renal aguda é uma das complicações mais comuns do transplante ortotópico de fígado. A ausência de critério universal para sua definição nestas condições dificulta as comparações entre os estudos. A técnica convencional para o transplante consiste na excisão total da veia cava inferior retro-hepática durante a hepatectomia nativa. Controvérsias sobre o efeito da técnica convencional sem desvio venovenoso na função renal continuam. Objetivo -Estimar a incidência e os fatores de risco de injúria renal aguda entre os receptores de transplante ortotópico de fígado convencional sem desvio venovenoso. Métodos -Foram avaliados 375 pacientes submetidos a transplante ortotópico de fígado. Foram analisadas as variáveis pré, intra e pós-operatórias em 153 pacientes submetidos a transplante ortotópico de fí...