Post‐liver transplant acute renal failure: factors predicting development of end‐stage renal disease*

Paramesh, Anil; Roayaie, Sasan; Doan, Yvette; Schwartz, Myron; Emre, Sükrü; Fishbein, Thomas M.; Florman, Sander; Gondolesi, Gabriel; Krieger, Nancy; Ames, Scott; Bromberg, Jonathan S.; Akalin, Enver

doi:10.1046/j.1399-0012.2003.00132.x

Cited by 134 publications

(104 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Thirteen of our patients developed acute renal failure with an increase in serum creatinine concentration and required renal replacement therapy because of uraemic complications or an imbalance in fluid or acid-basemetabolism. The rate of 18% of patients requiring renal replacement therapy after orthotopic liver transplantation is consistent with that reported in previous studies (10-25%) [4,6,8,9,[13][14][15][16]. Patients with acute renal failure had a significantly higher incidence of posttransplant complications.…”

Section: Discussionsupporting

confidence: 89%

Development of a risk stratification model for predicting acute renal failure in orthotopic liver transplantation recipients*

Rueggeberg¹,

Boehm²,

Napieralski³

et al. 2008

Anaesthesia

View full text Add to dashboard Cite

SummaryThe purpose of this prospective observation cohort study was to develop and validate a risk stratification model for prediction of acute renal failure after liver transplantation. Data from 71 orthotopic liver transplantation recipients were used to develop a risk stratification model by binary logistic regression analysis containing the following variables: pretransplant hepatitis B and ⁄ or C infection; arterial hypertension; intra-operative mean arterial blood pressure before induction of anaesthesia; units of packed red blood cells required; hypotension (mean arterial blood pressure £50 mmHg); and maximum lactate concentration. Validation of the model on 167 consecutive patients revealed a sensitivity of 0.78, a specifity of 0.92, a negative predictive value of 0.96 and a positive predictive value of 0.62. This risk stratification model enables identification of orthotopic liver transplantation recipients with no or low risk for acute renal failure directly at the end of the transplantation procedure. Acute renal failure is a common and severe complication after major surgery and organ transplantation. In a population-based cohort analysis including 69 321 patients after non-renal organ transplantation, 7.6% of the patients developed postoperative acute renal failure (defined by 50% reduction in glomerular filtration rate or a need for urgent dialysis) [1]. Previous estimations of the incidence of acute renal failure after orthotopic liver transplantation in adults vary between 31% and 94%, depending on the definition used [2][3][4][5][6]. Its multifactorial origin complicates the identification of risk factors to develop prevention strategies. Acute renal failure can occur early in the postoperative course and seems to be related to pre-operative conditions and to the operative procedure. Impaired renal function and especially the need for post-transplant renal replacement therapy is associated with prolonged hospitalisation, increased mortality [2,[7][8][9], and significant financial cost [10].These observations prompted this prospective observational study, with the aim of developing a prediction model to identify patients at risk for acute renal failure requiring renal replacement therapy directly at the end of the transplantation procedure. Therefore we investigated only pre-and intra-operative risk factors for the development of acute renal failure after orthotopic liver transplantation, postoperative risk factors such as nephrotoxic drugs or postoperative complications having been extensively studied in the past.

show abstract

Section: Discussionsupporting

confidence: 89%

Development of a risk stratification model for predicting acute renal failure in orthotopic liver transplantation recipients*

Rueggeberg¹,

Boehm²,

Napieralski³

et al. 2008

Anaesthesia

View full text Add to dashboard Cite

show abstract

“…Neste estudo, utilizando os critérios propostos por PARAMESH et al (41) , verificou-se não haver diferença estatisticamente significante em relação à sobrevida, entre pacientes com ou sem disfunção renal.…”

Section: Resultsunclassified

Aplicação do escore MELD em pacientes submetidos a transplante de fígado: análise retrospectiva da sobrevida e dos fatores preditivos a curto e longo prazo

Boin

Leonardi

Udo

et al. 2008

Arq. Gastroenterol.

View full text Add to dashboard Cite

RESUMO -Racional -Utiliza-se o escore MELD (Model End-Stage Liver Disease) para o prognóstico da mortalidade em lista de espera para transplante de fígado e, em alguns estudos, para predição da sobrevida pós-operatória a longo prazo. Objetivo -Verificar a aplicação do escore MELD como predição da sobrevida após o transplante. Métodos -Por intermédio de dados coletados prospectivamente efetuou-se um estudo de coorte longitudinal retrospectivo em 232 pacientes. Excluíram-se os retransplantes, insuficiência hepática aguda, crianças e enxertos duplos ou reduzidos. Avaliaram-se os dados dos doadores: idade, sexo, peso, creatinina, bilirrubina, sódio, aspartato aminotransferase, antecedentes pessoais, causa da morte, presença de esteatose, número de critérios expandidos do doador e índice de risco do doador. Em relação aos receptores, analisaram-se as variáveis: sexo, idade, peso, doença hepática, pontos de Child-Turcotte-Pugh, escore MELD, depuração de creatinina, sódio, tempos de isquemia e de hospitalização, quantidade de hemoderivados transfundidos, presença e grau de disfunção do enxerto. A análise estatística foi efetuada usando-se a análise de regressão univariada e/ou múltipla, estatística 'c', teste exato de Fisher, método de Kaplan-Meier (teste log-rank) para sobrevida, e análise de regressão de Cox para risco de óbito ajustado para as condições clínicas. Resultados -O ponto de corte MELD para sobrevida foi 20 e de Child-Turcotte-Pugh foi 11,5. Para escore MELD maior ou igual a 20, os fatores preditivos de sobrevida foram: volume de sangue transfundido, disfunção do enxerto e o sódio do doador. Para os hiponatrêmicos os fatores preditivos de sobrevida foram: volume de sangue transfundido, disfunção do enxerto e sódio do doador. A sobrevida estimada para pacientes com escore MELD ≥25 foi menor ao final de 12 meses (68,86% vs 39,13%). A sobrevida estimada para os pacientes sem hiponatremia foi maior (65,16% vs 44,44%). A sobrevida aos 5 e 10 anos também seguiu o mesmo padrão. O uso de doadores limítrofes não alterou a sobrevida, mas quando se utilizou o índice de risco do doador observou-se que a sobrevida foi maior para pacientes com índice de risco do doador menor que 1,7 (63,62% vs 53,70%). A associação deste índice com o escore MELD não mostrou diferença estatística em relação à sobrevida. Observou-se que a falência e disfunção do enxerto foram associadas ao número crescente de critérios expandidos do doador. Os receptores de doadores maiores de 50 anos tiveram menor sobrevida (65,58% vs 38,40%) e o escore delta-MELD não discriminou a sobrevida. Conclusão -A sobrevida dos receptores a curto e longo prazo é associada a escores MELD acima de 25, ao volume de sangue transfundido, à disfunção do enxerto, à hiponatremia, à idade do doador acima de 50 anos e àqueles doadores com índice de risco do doador acima de 1,7. DESCRITORES -Transplante de fígado. Sobrevida. Doadores de tecidos. Índices de gravidade de doenças. INTRODUÇÃOO transplante de fígado vem sendo usado como terapia para doenças hepáticas terminais ...

show abstract

“…[2][3][4][5][7][8][9] Delaying the initiation of CNI with anti-thymocyte globulin in patients at high risk of acute renal failure was associated with a recovery in renal function in the early posttransplant period. Patients on this regimen also experienced a continual improvement in renal function, with a greater independence from dialysis, higher estimated GFR, and lower serum creatinine levels than control patients at 12 months posttransplant.…”

Section: Discussionmentioning

confidence: 99%

“…2,[4][5][6][7] Many risk factors such as preexisting renal impairment, hepatorenal syndrome, diabetes mellitus, liver allograft dysfunction, significant intraoperative blood loss, infection, and exposure to nephrotoxic calcineurin inhibitors (CNIs) have been reported to be associated with early renal dysfunction and acute renal failure after liver transplantation. 1,2,[8][9][10][11] Various strategies have been investigated to minimize the risk of acute renal failure after orthotopic liver transplantation, such as optimization of hemodynamic conditions in the operative and perioperative periods, but these strategies have not been successful. [12][13][14][15] Delaying the initiation of the nephrotoxic CNIs cyclosporine and tacrolimus until renal function recovers appears to be a logical approach to minimize early renal dysfunction in liver transplantation.…”

mentioning

confidence: 99%

Preserving renal function in liver transplant recipients with rabbit anti-thymocyte globulin and delayed initiation of calcineurin inhibitors

et al. 2007

View full text Add to dashboard Cite

Early renal dysfunction following liver transplantation is associated with increased morbidity and mortality. To evaluate the impact of delayed initiation of calcineurin inhibitor on renal function, we conducted a retrospective study comparing 118 liver transplant recipients who received rabbit anti-thymocyte globulin and delayed initiation of calcineurin inhibitor with 80 liver transplant recipients who received no antibody and early initiation of calcineurin inhibitor (control group). All patients received mycophenolate mofetil and steroids. Delayed calcineurin inhibitor initiation with anti-thymocyte globulin was associated with significant improvement in renal function throughout the first year post-transplant. At 12 months post-transplant, patients treated with this regimen experienced lower serum creatinine (1.4 Ϯ 0.5 versus 1.7 Ϯ 0.5 mg/dL, P Ͻ 0.001), a higher estimated glomerular filtration rate (57.4 Ϯ 20.5 versus 43.7 Ϯ 14.4 mL/min/1.73 m 2 , P Ͻ 0.001), and less dependence on dialysis (0.8% versus 13%, P Ͻ 0.001) in comparison with no antibody and early calcineurin inhibitor initiation. Patient survival and graft survival were similar between groups; however, there was a trend of a lower incidence of early biopsy-proven acute rejection with anti-thymocyte globulin. Overall infection and cytomegalovirus infection were significantly lower in anti-thymocyte globulin-treated patients, and there was no increased incidence of hepatitis C recurrence in comparison with controls. In conclusion, delayed initiation of calcineurin inhibitor with anti-thymocyte globulin in liver transplant recipients is safe and is associated with improvements in renal function and a lower incidence of early acute rejection in comparison with no antibody and early initiation of calcineurin inhibitor. Liver Transpl 14: 66-72, 2008.

show abstract

Post‐liver transplant acute renal failure: factors predicting development of end‐stage renal disease*

Cited by 134 publications

References 20 publications

Development of a risk stratification model for predicting acute renal failure in orthotopic liver transplantation recipients*

Development of a risk stratification model for predicting acute renal failure in orthotopic liver transplantation recipients*

Aplicação do escore MELD em pacientes submetidos a transplante de fígado: análise retrospectiva da sobrevida e dos fatores preditivos a curto e longo prazo

Preserving renal function in liver transplant recipients with rabbit anti-thymocyte globulin and delayed initiation of calcineurin inhibitors

Contact Info

Product

Resources

About