Preoperative and Perioperative Predictors of the Need for Renal Replacement Therapy After Orthotopic Liver Transplantation

Sanchez, Edmund Q.; Gonwa, Thomas A.; Levy, Marlon F.; Goldstein, Robert M.; Martin, L.; Hays, Steven R.; Melton, L. A.; Saracino, Giovanna; Klintmalm, Göran B.

doi:10.1097/01.tp.0000137176.95730.5b

Cited by 108 publications

(121 citation statements)

References 26 publications

(28 reference statements)

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“…During the operation, patients with acute renal failure needed more red blood cell units [4,15,20], indicating a higher blood loss which may also predispose to renal dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…This temporal validation by evaluating a second data set from the same centre is independent of the original data set and the model-fitting process [21]. Sanchez et al [20] developed in their retrospective study a model to predict acute renal failure, including a score for end-stage liver disease (MELD) and a postoperative stay of more than three days in the ICU. The factors pre-operative creatinine concentration and blood-urea nitrogen did not appear in our model, probably because they are weak predictors in comparison to intra-operative haemodynamic data, which were not mentioned by Sanchez et al Use of the MELD score in combination end stage liver disease was first published in 2001, so we did not include it in our prospective study, which started in August 2000.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Rueggeberg¹,

Boehm²,

Napieralski³

et al. 2008

Anaesthesia

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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.

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“…During the operation, patients with acute renal failure needed more red blood cell units [4,15,20], indicating a higher blood loss which may also predispose to renal dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

“…Preliminary results from centers with small number of patients and with limited posttransplant information suggest that histological criteria can be used in selecting SLK transplant candidates (13)(14)(15) (13,18). This lack of agreement might also explain why preliver transplant GFR does not consistently predict postliver transplant renal function (19)(20)(21) (8,12,(22)(23)(24) (25,26 (27). Similarly, native kidney biopsy studies document a 2.3-folds increased risk of postbiopsy bleeding in patients with advanced renal failure (25,28).…”

Section: Kidney Allocation To Liver Transplant Candidates With Renal mentioning

confidence: 99%

Kidney Allocation to Liver Transplant Candidates with Renal Failure of Undetermined Etiology: Role of Percutaneous Renal Biopsy

Wadei

Geiger²,

Cortese³

et al. 2008

American Journal of Transplantation

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The feasibility, value and risk of percutaneous renal biopsy (PRB) in liver transplant candidates with renal failure are unknown. PRB was performed on 44 liver transplant candidates with renal failure of undetermined etiology and glomerular filtration rate (GFR) <40 mL/min/1.73 m 2 (n = 37) or on renal replacement therapy (RRT) (n = 7). Patients with ≥30% interstitial fibrosis (IF), ≥40% global glomerulosclerosis (gGS) and/or diffuse glomerulonephritis were approved for simultaneous-liver-kidney (SLK) transplantation. Prebiopsy GFR, urinary sodium indices, dependency on RRT and kidney size were comparable between 27 livertransplant-alone (LTA) and 17 SLK candidates and did not relate to the biopsy diagnosis. The interobserver agreement for the degree of IF or gGS was moderateto-excellent. After a mean of 78 ± 67 days, 16 and 8 patients received LTA and SLK transplants. All five LTA recipients on RRT recovered kidney function after transplantation and serum creatinine was comparable between LTA and SLK recipients at last followup. Biopsy complications developed in 13, of these, five required intervention. PRB is feasible in liver transplant candidates with renal failure and provides reproducible histological information that does not relate to the pretransplant clinical data. Randomized studies are needed to determine if PRB can direct kidney allocation in this challenging group of liver transplant candidates.

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“…6 After a liver transplant, changes in serum creatinine are common because of hemodynamic factors in the peritransplant period. This study shows that AKI has an important effect on long-term renal function and patient and graft survival after a liver transplant.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2014

Exp Clin Transplant

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Objectives: Acute renal injury is a common complication in liver transplant patients. Acute kidney injury is due to nephrotoxic drugs used after liver transplant, infections, and hemorrhage. Though it is generally reversible, it has effects on grafts and patients survival. In this retrospective observational study carried out at a single center, the effects of acute renal disease on liver recipient's survival were investigated. Materials and Methods: Liver transplant recipients of live-donor and deceased-donor transplants between January 2002 and May 2013 were included in this study; there were 310 liver transplant patients (mean age, 28 y; age range, 6 mo-62 y; 165 males, 145 females). The acute kidney disease diagnosis and staging was based on the nephrology department evaluation and daily serum creatinine levels. Patients with acute kidney injury before undergoing liver transplant and those undergoing a transplant for the second time were excluded. Kidney functions were evaluated by the nephrology department 1 week, 3 months, and 1 year after the liver transplant. Results: Acute kidney disease rates in these patients were 5%, 8%, and 12%. Four patients developed chronic kidney failure during follow-up. The mortality rate was higher (18%) in acute renal failure patients compared with those that did not have acute renal failure. The mortality rate was 11% in patients without acute renal failure.Conclusions: Acute renal injury is common after liver transplant and has an effect on mortality.

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Preoperative and Perioperative Predictors of the Need for Renal Replacement Therapy After Orthotopic Liver Transplantation

Abstract: This model allowed us to identify patients at high risk for developing the need for RRT postoperatively. Strategies for these patients to prevent or ameliorate acute renal failure and reduce the need for RRT postoperatively are needed.

Cited by 108 publications

References 26 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*

Kidney Allocation to Liver Transplant Candidates with Renal Failure of Undetermined Etiology: Role of Percutaneous Renal Biopsy

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