Hepatic Venous Outflow Obstruction in Polycystic Liver Disease

Abstract

Introduction: Skin autofluorescence (SAF) reflects accumulation of advanced glycation end-products (AGEs), which is known to impair renal function. The aim of this study was to assess usefulness of SAF measurement in prediction of acute kidney injury (AKI) in patients undergoing liver resection. Methods: This prospective observational study was performed on 130 patients undergoing liver resection in the Department of General, Transplant and Liver Surgery (Medical University of Warsaw) between 2018 and 2019. The primary outcome measure was AKI, as defined by Kidney Disease Improving Global Guidelines criteria. SAF, the primary factor of interest, was based on 3 separate preoperative measurements on the anterior side of the forearm and expressed in arbitrary units (AU). Results: AKI was observed in 26 of 130 patients (20.0%). SAF was an independent predictor of AKI (odds ratio [OR] 2.90; 95% confidence interval [95% CI] 1.33 -6.32; p=0.008), along with the extent of liver resection (OR 2.91; 95% CI 1.68 -5.04; p< 0.001). Optimal cut-off for SAF in prediction of AKI was 2.4 AU (area under the curve 0.676, 95% CI 0.564-0.787; p=0.002), with positive and negative predictive values of 28.3% and 87.1%, respectively. The rates of AKI were 2.5% and 11.8% in patients undergoing minor liver resection with low and high SAF, respectively, and 26.7% and 50.0% in patients undergoing major liver resection with low and high SAF, respectively (p< 0.001). Conclusions: SAF measurement is useful in prediction of AKI in patients undergoing liver resection and point towards the pathogenetic role of AGEs.