Risk factors for acute kidney injury following orthotopic liver transplantation: the impact of changes in renal function while patients await transplantation

Abstract

BackgroundAcute kidney injury (AKI) occurs commonly in the setting of orthotopic liver transplantation (OLT). To date, the correlation between AKI post-OLT and pre-operative changes in renal function has not been rigorously examined.MethodsTo determine the impact of pre-OLT changes in renal function on AKI post-OLT, as well as to identify risk factors for AKI, we analyzed the prospectively maintained NIDDK Liver Transplantation Database, which includes patients who received their first OLT between April 15, 1990, and June 30, 1994. We used the AKI Network definition of AKI.ResultsSurprisingly, univariate analysis revealed that worsening renal function while awaiting OLT was protective to the development of AKI post-OLT. Independent predictors of AKI were increased body mass index, increased Childs-Pugh-Turcott score, decreased urine output during cross-clamp, improved renal function while awaiting OLT, increased post-operative stroke volume, non-Caucasian race, and post-operative use of tacrolimus.ConclusionsThe correlation between improving renal function pre-OLT and AKI post-OLT may represent true protection (via ischemic pre-conditioning) or, alternatively, a masking of milder forms of AKI (via improved renal perfusion through correction of the cirrhotic milieu). These results highlight the complex interaction between liver and kidney disease, and suggest that not only the etiology but also the course of pre-OLT renal dysfunction may be a critical determinant of renal function post-OLT.

Predictors of Acute Kidney Injury in Septic Shock Patients

“…These observations confirm the findings of previous studies (6,8,36). In agreement with our study, higher BMI has been linked to renal failure (37,38) and has been shown to be an independent risk factor for developing AKI in ICU patients in general (39), as well as in specific subgroups such as septic (8) or liver transplant patients (40). It is no surprise that ACEI/ ARB use was an independent predictor of AKI.…”

Postoperative kidney injury does not decrease survival after liver transplantation

“…The 15,17 , preoperative decreased renal function 7,17 , hemocomponents transfusion 1,5,18 , postreperfusion syndrome 5,19 and surgical technique 1,2 have been highlighted in the most current literature. Some preoperative co-morbidity such as hypertension, obesity (i.e.…”

“…Some preoperative co-morbidity such as hypertension, obesity (i.e. : increased BMI) and diabetes mellitus have also been related to outcomes after OLT when the renal dysfunction is explored in the settings of OLT 4,7,20 . Using this same cohort, we previous presented that patient/liver disease severity (i.e.…”

“…The conventional technique of orthotopic liver transplantation (OLT) has been pointed as associated with increased rate of postoperative acute kidney injury (AKI) [1][2][3] ; an overall major and frequent complication after OLT [4][5][6][7] . Following these patients, we have not found serious complications inherent to this approach 8,9 ; however, whether this complication may contribute to independently decrease post-transplant survival remains unclear.…”

Preditores de injúria renal aguda em pacientes submetidos ao transplante ortotópico de fígado convencional sem desvio venovenoso

“…Among the studies was found discrepancies (13% to 94%) in incidence, and this occurred due to lack of consensus on the definition of ARF after liver transplantation 35 . The preoperative AKI is considered a risk factor for the development of ARF in transplants 12 . The preoperative renal function, assessed by serum creatinine, is part of the MELD score is a stratification of patients on the waiting list for liver transplantation 14,30 .…”