Impact of acute kidney injury exposure period among liver transplantation patients

Abstract

BackgroundAcute kidney injury is a common complication of liver transplantation. In this single-centre retrospective observational study, we investigated the impact of acute kidney disease on liver recipient survival.MethodsThe study population consisted of patients who underwent a liver engraftment between January 2002 and November 2006, at a single transplantation centre in São Paulo, Brazil. Acute kidney injury diagnosis and staging were according to the recommendations of the Acute Kidney Injury Network and consisted of scanning the daily serum creatinine levels throughout the hospital stay. Patients requiring renal replacement therapy prior to transplantation, those who developed acute kidney injury before the procedure or those receiving their second liver graft were excluded from the study.ResultsA total of 444 liver transplantations were performed during the study period, and 129 procedures (29%) were excluded. The remaining 315 patients constituted the study population. In 207 procedures, the recipient was male (65%). The mean age of the population was 51 years. Cumulative incidence of acute kidney injury within 48 h, during the first week after transplantation, and throughout the hospital stay was 32, 81 and 93%, respectively. Renal replacement therapy was required within a week after the transplantation in 31 procedures (10%), and another 17 (5%) required replacement therapy after that period. Mean follow-up period was 2.3 years. Time in days from acute kidney injury diagnosis to initiation of replacement therapy or reaching serum creatinine peak was associated with lower overall survival even when adjusted for significant potential confounders (HR 1.03; 95% CI 1.01, 1.05; p=0.002). Overall, patients experiencing acute kidney injury lasting for a week or more before initiation of replacement therapy experienced a threefold increase in risk of death (HR 3.02; 95% CI 2.04, 4.46; p<0.001).ConclusionsAcute kidney injury after liver transplantation is remarkably frequent and has a substantial impact on patient survival. Delaying the initiation of renal replacement therapy in such population may increase mortality by more than 20% per day.

Ulinastatin ameliorates acute kidney injury following liver transplantation in rats and humans

“…Thus, the American Society of Nephrology has indicated that the diagnosis of renal failure may be replaced by AKI, which may aid the earlier prognosis of renal failure and provide effective prevention for the further deterioration of renal function in patients. AKI is a common and significant complication of liver transplantation, and is responsible for the poor prognosis of OLT patients ( 16 – 18 ). However, no effective methods for the prevention of AKI are currently available.…”

Incidence and Impact of Acute Kidney Injury after Liver Transplantation: A Meta-Analysis

“…Recent studies have suggested several important factors that influence post-LTx AKI, including hepatic ischemia-reperfusion injury (HIRI) [36,37,38], increased use of high-risk or marginal grafts, and transplantation of liver grafts to sicker patients with higher Model For End-Stage Liver Disease (MELD) score or with more comorbidities [23,39,40,41,42,43,44,45,46,47,48,49,50,51]. In our literature review, the reported incidences are a farrago, having a range between 5% to 94% [10,11,14,15,16,17,18,19,20,21,22,23,24,25,28,29,30,31,32,33,34,35,39,40,41,42,43,44,45,46,47,48,49,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,…”

“…In our literature review, the reported incidences are a farrago, having a range between 5% to 94% [10,11,14,15,16,17,18,19,20,21,22,23,24,25,28,29,30,31,32,33,34,35,39,40,41,42,43,44,45,46,47,48,49,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80]. These wide variabilities are possibly due to non-uniform definitions of AKI [10,11,14,15,16,17,18,19,20,21,22,2...…”

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“…The MELD score is reportedly a useful qualitative variable for evaluating patients with liver disease for AKI. However, different cutoff scores are reported in the literature (22 by Barreto et al 7 and 13 by Narciso et al 11 ) to predict which patients are at high risk of developing severe renal dysfunction; the mean MELD score was 16.7 in our series, which reflects the intermediate liver function in our patients. When we compared the MELD scores of early and delayed RRT patients, we found higher MELD scores in patients whose RRT is initiated early.…”