Liver Transplant Patients with High Levels of Preoperative Serum Ammonia Are at Increased Risk for Postoperative Acute Kidney Injury: A Retrospective Study

Lee, Yoon Sook; Choi, Yoon-Dong; Park, Kyu Hee; Park, Byeong Seon; Son, Jungmin; Park, Ju Yeon; Ri, Hyun-Su; Ryu, Je Ho

doi:10.3390/jcm9061629

Cited by 5 publications

(3 citation statements)

References 38 publications

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“…Similarities of matched groups in all aspects (preoperative variables and patient demographics) could well balance the confounding factors of retrospective cohort study, for maintaining baselines consistency in two groups and reducing selection bias. Unlike in previous studies [7], we excluded patients with fulminant hepatic failure, for these patients often already received massive blood transfusion before LT, and were often accompanied with severe comorbidities, such as gastrointestinal bleeding, severe infection, hepatorenal syndromes and requiring preoperative RRT, also with high MELD scores [31][32][33][34]. We thought that severe pre-existing comorbidities might easily become uncontrollable confounding factor and interfere with the research results.…”

Section: Discussionmentioning

confidence: 99%

Impact of Perioperative Massive Transfusion on Long Term Outcomes of Liver Transplantation: a Retrospective Cohort Study

Tan¹,

Xiao-zhen²,

Yue³

et al. 2021

Int. J. Med. Sci.

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Background: Liver transplantation (LT) is associated with a significant risk of intraoperative hemorrhage and massive blood transfusion. However, there are few relevant reports addressing the long-term impacts of massive transfusion (MT) on liver transplantation recipients. Aim: To assess the effects of MT on the short and long-term outcomes of adult liver transplantation recipients. Methods: We included adult patients who underwent liver transplantation at West China Hospital from January 2011 to February 2015. MT was defined as red blood cell (RBC) transfusion of ≥10 units within 48 hours since the application of LT. Preoperative, intraoperative and postoperative information were collected for data analyzing. We used one-to-one propensity-matching to create pairs. Kaplan-Meier survival analysis was used to compare long-term outcomes of LT recipients between the MT and non-MT groups. Univariate and multivariate logistic regression analyses were performed to evaluate the risk factors associated with MT in LT. Results: Finally, a total of 227 patients were included in our study. After propensity score matching, 59 patients were categorized into the MT and 59 patients in non-MT groups. Compared with the non-MT group, the MT group had a higher 30-day mortality (15.3% vs 0, p=0.006), and a higher incidence of postoperative complications, including postoperative pulmonary infection, abdominal hemorrhage, pleural effusion and severe acute kidney injury. Furthermore, MT group had prolonged postoperative ventilation support (42 vs 25 h, p=0.007) and prolonged durations of ICU (12.9 vs 9.5 d, p<0.001) stay. Multivariate COX regression indicated that massive transfusion (OR: 2.393, 95% CI: 1.164-4.923, p=0.018) and acute rejection (OR: 7.295, 95% CI: 2.108-25.246, p=0.02) were significant risk factors affecting long-term survivals of LT patients. The 1-year and 3-year survival rates patients in MT group were 82.5% and 67.3%, respectively, while those of non-MT group were 93.9% and 90.5%, respectively. The MT group exhibited a lower long-term survival rate than the non-MT group (HR: 2.393, 95% CI: 1.164-4.923, p<0.001). Finally, the multivariate logistic regression revealed that preoperative hemoglobin <118 g/L (OR: 5.062, 95% CI: 2.292-11.181, p<0.001) and intraoperative blood loss ≥1100 ml (OR: 3.212, 95% CI: 1.586-6.506, p = 0.001) were the independent risk factor of MT in patients undergoing LT. Conclusion: Patients receiving MT in perioperative periods of LT had worse short-term and long-term outcomes than the non-MT patients. Massive transfusion and acute rejection were significant risk factors affecting long-term survivals of LT patients, and intraoperative blood loss of over 1100 ml was the independent risk factor of MT in patients undergoing LT. The results may offer valuable information on perioperative management in LT recipients who experience high risk of MT.

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Section: Discussionmentioning

confidence: 99%

Impact of Perioperative Massive Transfusion on Long Term Outcomes of Liver Transplantation: a Retrospective Cohort Study

Tan¹,

Xiao-zhen²,

Yue³

et al. 2021

Int. J. Med. Sci.

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“…Despite advances in organ preservation, surgical techniques, and improvements in immunosuppression programs, the incidence of post-OLT AKI remains high. Probably due to inconsistent definitions of AKI in different articles, the incidence of post-OLT AKI ranges between 5% and 95%, and 8%∼17% of these patients require renal replacement therapy (RRT) [ 2–4 ].…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a nomogram for predicting acute kidney injury after orthotopic liver transplantation

et al. 2021

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Background We aim to develop and validate a nomogram model for predicting severe acute kidney injury (AKI) after orthotopic liver transplantation (OLT). Methods A total of 576 patients who received OLT in our center were enrolled. They were assigned to the development and validation cohort according to the time of inclusion. Univariable and multivariable logistic regression using the forward variable selection routine were applied to find risk factors for post-OLT severe AKI. Based on the results of multivariable analysis, a nomogram was developed and validated. Patients were followed up to assess the long-term mortality and development of chronic kidney disease (CKD). Results Overall, 35.9% of patients were diagnosed with severe AKI. Multivariable logistic regression analysis revealed that recipients’ BMI (OR 1.10, 95% CI 1.04–1.17, p = 0.012), hypertension (OR 2.32, 95% CI 1.22–4.45, p = 0.010), preoperative serum creatine (sCr) (OR 0.96, 95% CI 0.95–0.97, p < 0.001), and intraoperative fresh frozen plasm (FFP) transfusion (OR for each 1000 ml increase 1.34, 95% CI 1.03–1.75, p = 0.031) were independent risk factors for post-OLT severe AKI. They were all incorporated into the nomogram. The area under the ROC curve (AUC) was 0.73 ( p < 0.05) and 0.81 ( p < 0.05) in the development and validation cohort. The calibration curve demonstrated the predicted probabilities of severe AKI agreed with the observed probabilities ( p > 0.05). Kaplan-Meier survival analysis showed that patients in the high-risk group stratified by the nomogram suffered significantly poorer long-term survival than the low-risk group (HR 1.92, p < 0.01). The cumulative risk of CKD was higher in the severe AKI group than no severe AKI group after competitive risk analysis (HR 1.48, p < 0.05). Conclusions With excellent predictive abilities, the nomogram may be a simple and reliable tool to identify patients at high risk for severe AKI and poor long-term prognosis after OLT.

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“…Increased levels of the biomarkers are associated with evaluated NH 3 concentrations in the body, which could be quantifiable. Many studies confirmed the relation between NH 3 , urea, and creatinine levels in patients with kidney disease. ,, For instance, Narasimhan et al revealed that there is a correlation between urea levels and concentrations of NH 3 in the exhaled breath (EB) for hemodialysis therapy (95%). In an interesting work, Shahmoradi et al employed a gas sensor to measure NH 3 in the breath of hemodialysis patients.…”

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confidence: 94%

Design and Fabrication of a Gas Sensor Based on a Polypyrrole/Silver Nanoparticle Film for the Detection of Ammonia in Exhaled Breath of COVID-19 Patients Suffering from Acute Kidney Injury

et al. 2022

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One of the serious complications of COVID-19 is acute kidney injury (AKI), leading to a decrease in kidney function and even death. The concentration of ammonia (NH 3 ) in the exhaled breath (EB) of COVID-19 patients suffering from AKI symptoms will be significantly increased. In this work, the detection of breath NH 3 was performed at gold interdigital electrodes modified with a soluble polypyrrole microparticle and silver nanoparticle film (Au-IDEs/S-PPyMPs/AgNPs) as a noninvasive chemiresistor gas sensor. The response behavior of unmodified and modified gas sensors toward NH 3 and other interfering compounds was studied. The Au-IDEs/S-PPyMPs/AgNPs exhibited NH 3 detection in the linear dynamic range of 1.00−19.23 ppm, with a limit of detection of 0.12 ppm. Finally, the fabricated gas sensor was used to monitor the NH 3 concentration in the EB of COVID-19 patients suffering from AKI symptoms. For this purpose, the gas sensor was validated in 19 EB samples (seven COVID-19−positive patients, four COVID-19−negative patients, and eight post−COVID-19 patients). The gas sensor was directly exposed to the EB samples, followed by recording the changes in electrical resistance via a low-cost digital multimeter. The sensing mechanism was explained as the interaction between breath NH 3 and sensing materials. The breath NH 3 concentrations have a desirable correlation (R 2 = 0.8463) with the estimated glomerular filtration rate (eGFR) values in COVID-19−positive patients. The fabricated gas sensor can distinguish COVID-19−positive patients suffering from AKI symptoms from COVID-19−negative patients and post−COVID-19 patients. The present work can pave the way for the development of a simple and efficient analytical approach for COVID-19 patients with AKI without the need for sample pretreatment.

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Liver Transplant Patients with High Levels of Preoperative Serum Ammonia Are at Increased Risk for Postoperative Acute Kidney Injury: A Retrospective Study

Cited by 5 publications

References 38 publications

Impact of Perioperative Massive Transfusion on Long Term Outcomes of Liver Transplantation: a Retrospective Cohort Study

Impact of Perioperative Massive Transfusion on Long Term Outcomes of Liver Transplantation: a Retrospective Cohort Study

Development and validation of a nomogram for predicting acute kidney injury after orthotopic liver transplantation

Design and Fabrication of a Gas Sensor Based on a Polypyrrole/Silver Nanoparticle Film for the Detection of Ammonia in Exhaled Breath of COVID-19 Patients Suffering from Acute Kidney Injury

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