Acute Renal Injury Evaluation After Liver Transplantation: With RIFLE Criteria

Erdost, Hale Aksu; Özkardeşler, Sevda; Öçmen, Elvan; Avkan-Oğuz, Vildan; Akan, Mert; İyilikçi, Leyla; Ünek, Tarkan; Özbilgin, Mücahit; Dalak, Reci Meseri; Astarcıoğlu, İbrahim

doi:10.1016/j.transproceed.2015.04.065

Cited by 26 publications

(16 citation statements)

References 25 publications

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“…AKI is a common and critical complication and a major cause of morbidity and mortality after both OLT and LDLT, and the incidence varies according to the definition of AKI used . In our present results, the incidence of AKI was 60.5% in ABOc LDLT patients and 67.9% in ABOi LDLT patients, which seems comparable to or higher than previous reports .…”

Section: Discussionsupporting

confidence: 84%

“…In addition, hypotension due to inappropriate intravascular volume replacement after plasmapheresis might also be the possible cause of development of AKI in ABOi LDLT. According to previous studies, FFP transfusion was associated with a risk factor for postoperative AKI . Furthermore, the increased immunosuppression of the ABOi group (rituximab, methylprednisolone, and mycophenolate mofetil) may have played a role in the slightly increased rate of AKI in ABOi LDLT.…”

Section: Discussionmentioning

confidence: 89%

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Comparison of acute kidney injury between ABO‐compatible and ABO‐incompatible living donor liver transplantation: A propensity matching analysis

et al. 2016

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The anti-CD20 monoclonal antibody rituximab has significantly decreased the prevalence of antibody-mediated rejection of ABO-incompatible (ABOi) living donor liver transplantation (LDLT). However, little is known about acute kidney injury (AKI) following ABOi LDLT. The aim of this study was to identify the incidence of AKI in ABOi LDLT and compare it with that of ABO-compatible (ABOc) LDLT. We retrospectively collected and analyzed the data of 1617 patients who underwent liver transplant surgery from November 2008 to December 2014. Risk factors for AKI were investigated using multivariate regression analysis. In 271 ABOi LDLTs, AKI occurred in 184 (67.9%) according to Kidney Disease: Improving Global Outcomes criteria. After propensity score matching, the incidence of AKI was significantly higher after ABOi LDLT than after ABOc LDLT (67.0% versus 48.2%; P < 0.001). Furthermore, the intensive care unit stay (P = 0.01) was significantly prolonged, but there were no significant differences in mortality (P = 0.74), graft failure (P = 0.32), and postoperative dialysis (P = 0.74) between the 2 groups. Hemoglobin level and operation time were independent risk factors for AKI following ABOi LDLT. In conclusion, the incidence of AKI is higher in ABOi LDLT than ABOc LDLT. However, the impact of AKI on postoperative outcomes was not marked in our study. Therefore, ABOi LDLT in selected patients is promising with apparent good graft and survival outcomes. Liver Transplantation 22 1656-1665 2016 AASLD.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 89%

Comparison of acute kidney injury between ABO‐compatible and ABO‐incompatible living donor liver transplantation: A propensity matching analysis

et al. 2016

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“…Perioperative risk factors for the development of AKI post OLT have included pre-existing renal dysfunction, diabetes mellitus, hypertension, previous ascites, MELD score, surgical technique, intraoperative transfusion of blood products, ischaemia time, post-reperfusion syndrome and post OLT immunosuppression[24-26]. In our study, peak serum AST within 24 h of OLT, surgical technique and transfusion of blood products were all statistically significant in univariate analysis in being predictors of early AKI.…”

Section: Discussionmentioning

confidence: 54%

Early acute kidney injury after liver transplantation: Predisposing factors and clinical implications

Rahman

Davidson

Mallett

2017

WJH

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AIMTo investigate the additional clinical impact of hepatic ischaemia reperfusion injury (HIRI) on patients sustaining acute kidney injury (AKI) following liver transplantation.METHODSThis was a single-centre retrospective study of consecutive adult patients undergoing orthotopic liver transplantation (OLT) between January 2013 and June 2014. Early AKI was identified by measuring serum creatinine at 24 h post OLT (> 1.5 × baseline) or by the use of continuous veno-venous haemofiltration (CVVHF) during the early post-operative period. Patients with and without AKI were compared to identify risk factors associated with this complication. Peak serum aspartate aminotransferase (AST) within 24 h post-OLT was used as a surrogate marker for HIRI and severity was classified as minor (< 1000 IU/L), moderate (1000-5000 IU/L) or severe (> 5000 IU/L). The impact on time to extubation, intensive care length of stay, incidence of chronic renal failure and 90-d mortality were examined firstly for each of the two complications (AKI and HIRI) alone and then as a combined outcome.RESULTSOut of the 116 patients included in the study, 50% developed AKI, 24% required CVVHF and 70% sustained moderate or severe HIRI. Median peak AST levels were 1248 IU/L and 2059 IU/L in the No AKI and AKI groups respectively (P = 0.0003). Furthermore, peak serum AST was the only consistent predictor of AKI on multivariate analysis P = 0.02. AKI and HIRI were individually associated with a longer time to extubation, increased length of intensive care unit stay and reduced survival. However, the patients who sustained both AKI and moderate or severe HIRI had a longer median time to extubation (P < 0.001) and intensive care length of stay (P = 0.001) than those with either complication alone. Ninety-day survival in the group sustaining both AKI and moderate or severe HIRI was 89%, compared to 100% in the groups with either or neither complication (P = 0.049).CONCLUSIONHIRI has an important role in the development of AKI post-OLT and has a negative impact on patient outcomes, especially when occurring alongside AKI.

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“…PTRD after liver transplantation is common and is usually of the "risk" category according to the RIFLE classification. (22) It is usually multifactorial secondary to prolonged surgery, intraoperative blood loss, lowgrade perioperative sepsis, or tacrolimus therapy. A majority of these resolved spontaneously over the first posttransplant week.…”

Section: Discussionmentioning

confidence: 99%

Double‐blind randomized controlled trial of the routine perioperative use of terlipressin in adult living donor liver transplantation

Reddy

Kaliamoorthy²,

Rajakumar³

et al. 2017

Liver Transpl

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Perioperative terlipressin (Tp) during living donor liver transplantation (LDLT) has been shown to reduce intraoperative portal pressures and improve renal function. Its role and safety profile have never been evaluated in a double-blind randomized controlled trial (RCT). The aim was to evaluate the hemodynamic effects, clinical benefits, and safety of perioperative Tp infusion in adult LDLT. This was a single-center double-blind RCT. Consenting adults with chronic liver disease and low risk of posttransplant renal dysfunction undergoing their first LDLT were randomized. The study group (terlipressin group [TpG]) received an initial bolus of Tp during surgery followed by a Tp infusion for 72 hours in the postoperative period. The placebo group (PbG) received a saline infusion. The primary endpoint was portal pressure after arterial reperfusion. Multiple intraoperative and postoperative variables served as secondary endpoints. A total of 41 patients were enrolled in the trial (TpG, 21; PbG, 20). There were no significant differences in intraoperative portal pressures, blood loss, fluid requirement, vasopressor requirement, or urine output. Peak intraoperative and end of surgery lactate levels were significantly higher in the Tp group. There was no difference in postoperative liver function tests. Incidence of acute kidney injury as assessed by Risk, Injury, Failure, Loss, and End-Stage Kidney Disease criteria was lower in the Tp group (27% versus 60%; P = 0.04). The TpG had less postoperative ascites, a lower need for percutaneous interventions, and a shorter hospital stay. Incidence of bradycardia requiring pharmacological intervention and withdrawal from study was significantly higher in the TpG. In conclusion, this study has not demonstrated a reduction in postreperfusion portal pressure with Tp. However, Tp infusion reduced postoperative ascitic drain output resulting in less frequent percutaneous interventions and reduced hospital stay. Intraoperative hyperlactatemia and symptomatic bradycardia are major concerns. Its use should be restricted to patients with high-volume ascites, and it needs close monitoring during drug infusion. Liver Transplantation 23 1007-1014 2017 AASLD.

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Acute Renal Injury Evaluation After Liver Transplantation: With RIFLE Criteria

Cited by 26 publications

References 25 publications

Comparison of acute kidney injury between ABO‐compatible and ABO‐incompatible living donor liver transplantation: A propensity matching analysis

Comparison of acute kidney injury between ABO‐compatible and ABO‐incompatible living donor liver transplantation: A propensity matching analysis

Early acute kidney injury after liver transplantation: Predisposing factors and clinical implications

Double‐blind randomized controlled trial of the routine perioperative use of terlipressin in adult living donor liver transplantation

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