Acute Renal Failure in Liver Transplant Patients: Indian Study

Abstract

The acute renal failure is the frequent medical complication observed in liver transplant patients. The objective of this study was to determine the cause of acute renal failure in post liver transplant patients. A total of 70 patients who underwent (cadaveric 52, live 18) liver transplantation were categorized based on clinical presentation into two groups, namely hepatorenal failure (HRF, n = 29), and Hepatic failure (HF, n = 41). All the patients after the liver transplant had received tacrolimus, mycophenolate and steroids. We analyzed the modification of diet in renal disease, (MDRD) serum urea, creatinine and albumin before and after 5th and 30th day of liver transplant and data was categorized into survivors and non-survivors group. In HRF survivor group, serum creatinine, and urea levels were high and, albumin, MDRD were low in pre- transplant and reached to normal levels on 30th day of post transplant, and 79.3 % of patients in this group showed resumption of normal kidney function. On the contrary in HRF nonsurvivor group, we did not observed any significant difference and 20.7 % of patients showed irreversible changes after the liver transplant. In HF survivor group, 82.9 % of liver failure patients did not show any deviation in serum creatinine, urea, albumin and MDRD, whereas in HF non survivor group, 17.1 % of liver failure patients who had HCV positive before the transplant developed acute renal failure. The levels of creatinine, urea, albumin and MDRD were normal before the transplant and on day 30th, the levels of albumin and MDRD were significantly low whereas serum urea, creatinine levels were high. In conclusion, based on these observations, an diagnosis and treatment of Acute renal failure is important among the liver transplantation cases in the early postoperative period.

Risk factors of acute kidney injury after orthotopic liver transplantation in China

“…Various factors are associated with the occurrence of AKI, and some depend on the preoperative recipient’s condition, and others stem from intraoperative vascular and metabolic dynamics and postoperative complications 3 7 9 10 11 . Recipients may have had intrinsic renal disease, induced by obstructive uropathy hypotension 11 , cerebrovascular diseases 4 , diabetes mellitus 11 , or hepatorenal syndrome (HS) 12 before undergoing liver transplantation. Acute tubular necrosis (ATN) and glomerulonephritis mainly develop in patients with nephrotoxic drug use, cirrhosis, and IgA nephropathy, all of them thought as signs of AKI 13 .…”

“…Meanwhile, some investigations revealed that postoperative infection 19 , RRT induction 14 were independent risk factors of AKI complicated to OLT. However, some risk factors, which may cause AKI after OLT, are still controversial or even contradicting in different investigations 6 11 16 17 20 21 22 23 24 25 .…”

A randomized clinical trial of a parent-focused social-cognitive processing intervention for caregivers of children undergoing hematopoetic stem cell transplantation.

“…Despite improved survival statistics, pediatric HSCT remains a risky procedure. Depending on the type of transplant and disease, transplant-related mortality ranges between 20% and 55% in the 5 years following HSCT (Mehta et al, in press; Naik, Premsagar, & Mallikarjuna, 2015). …”

Evaluation of Factors Influencing Renal Dysfunction Following Living Donor Liver Transplantation

“…An earlier Indian study [27] on 70 patients who had undergone LT during 2005-09 was primarily on DDLT patients as there were only 18 (25.7%) LDLT patients in the cohort. The patients were grouped into those with both liver and renal failure (n=29) and those with hepatic failure but with normal renal function (n=41) prior to LT.…”