Acute kidney injury following liver transplantation: Definition and outcome

Abstract

The incidence of acute kidney injury (AKI) has been reported to vary between 17% and 95% post-orthotopic liver transplantation. This variability may be related to the absence of a uniform definition of AKI in this setting. The purpose of this study was to identify the degree of AKI that is associated with long-term adverse outcome. Furthermore, to determine the best definition (for use in future studies) of AKI not requiring dialysis in post-liver transplant patients, we retrospectively reviewed the effect of 3 definitions of AKI post-orthotopic liver transplantation on renal and patient outcome between 1997 and 2005. We compared patients with AKI to a control group without AKI by each definition. AKI was defined in 3 groups as an acute rise in serum creatinine, from the pretransplant baseline, of Ͼ0.5 mg/dL, Ͼ1.0 mg/dL, or Ͼ50% above baseline to a value above 2 mg/dL. In all groups, the glomerular filtration rate was significantly lower at both 1 and 2 years post-transplant. Patient survival was worse in all groups. Graft survival was worse in all groups. The incidence of AKI was highest in the group with a rise in creatinine of Ͼ0.5 mg/dL (78%) and lowest in patients with a rise in creatinine of Ͼ50% above 2.0 mg/dL (14%). Even mild AKI, defined as a rise in serum creatinine of Ͼ0.5 mg/dL, was associated with reduced patient and graft survival. However, in comparison with the other definitions, the definition of AKI with the greatest impact on patient's outcome post-liver transplant was a rise in serum creatinine of Ͼ50% above baseline to Ͼ2 mg/dL. See Editorial on Page 455Acute kidney injury (AKI) is a frequent complication post-liver transplantation. The incidence has been reported to range between 17% and 95% in different studies. [1][2][3][4] The etiology of AKI post-liver transplantation is usually multifactorial. These factors include surgeryrelated events, blood loss, hypotension, sepsis, calcineurin inhibitor (CNI)-induced vasoconstriction, and volume depletion. 4 At our institution, we tend to target a lower central venous pressure to protect the liver transplant against passive congestion with subsequent worsening of preservation injury in the immediate posttransplant period. Furthermore, renal dysfunction may be present prior to transplantation because of hepatorenal syndrome or other factors such as infections or intravascular volume depletion. [5][6][7] Therefore, a rise in serum creatinine is common post-liver transplantation. A high burden of chronic kidney disease (CKD) and end-stage renal disease (ESRD) has been reported postliver transplantation, most frequently due to CNI-induced nephrotoxicity.8 However, other factors may contribute to the development of this complication. 8,9 A report from our institution has shown that the incidence of ESRD is 9.5% after 13 years of follow-up postliver transplantation.10 AKI has been proposed to be an important risk factor for the long-term development of CKD and ESRD.9 However, most of the studies have been limited to AKI requiring renal replacement the...

Remote ischaemic preconditioning in orthotopic liver transplantation (RIPCOLT trial): a pilot randomized controlled feasibility study

“…Severe IR injury results in a systemic inflammatory response and end organ damage. AKI is a particular problem post AKI and documented rates in the literature range from 14% to 94% [29][30][31][32][33][34] . A recent audit of incidence of AKI at the Royal Free Hospital found that AKI occurs in around 50% of patients undergoing liver transplantation.…”

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“…Many variables, such as massive blood loss and secondary hypotension, a prolonged anhepatic phase, and intraoperative electrolyte and acid-base disorders, may cause acute kidney injury or further impairment of the renal function. [16][17][18] Several investigations have reported that massive intraoperative allogeneic red blood cell transfusions have a negative effect on liver transplant recipient outcomes. [19][20][21] Ramos and associates 22 confirmed that massive red blood cell transfusions are associated with longer hospital stays, and decreased postoperative survival for liver transplant recipients.…”

Critical Care Management after Adult Liver Transplantation

“…Sorunsuz bir KT sonrasında genellikle HRS iki-altı haftada iyileşme gösterir ancak transplantasyon öncesi 8-12 haftadan daha uzun süre hemodiyaliz uygulanan hastalarda kombine karaciğer-böbrek transplantasyonu düşünülmelidir. Transplantasyon öncesi ve postoperatif RRT gereksiniminin bağımsız bir mortalite prediktörü olduğu ve pre/post-operatif RRT uygulanan hastalarda mortalitenin daha yüksek olduğu gösterilmiştir (104)(105)(106)(107)(108)(109)(110)(111).…”