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Martucci G, Rossetti M, Li Petri S, Alduino R, Volpes R, Panarello G, Gruttadauria S, Burgio G, Arcadipane A. Continuous Renal Replacement Therapy after Liver Transplantation: Peri-Operative Associated Factors and Impact on Survival. J Clin Med 2022; 11:jcm11133803. [PMID: 35807086 PMCID: PMC9267513 DOI: 10.3390/jcm11133803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/22/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022] Open
Abstract
Continuous renal replacement therapy (CRRT) following orthotopic liver transplantation (OLT) is usually started for multifactorial reasons, with variable incidence among series. This paper presents a single-center retrospective observational study on the early use (within one week) of CRRT after consecutive cadaveric OLT from January 2008 to December 2016. Preoperative patient characteristics and intraoperative data were collected, and patients were divided into two groups (CRRT and no CRRT) to explore the factors associated with the use of CRRT. Repeated measurements of postoperative creatinine were analyzed with generalized estimating equation (GEE) models. Among 528 OLT patients, 75 (14.2%) were treated with CRRT at least once in the first week. Patients treated with CRRT showed lower survival in a Kaplan−Meier curve (log-rank p value < 0.01). Patients treated with CRRT had a more severe preoperative profile, with a significantly higher age, MELD, BUN, creatinine, and total bilirubin, as well as a longer surgery time and a higher number of transfusions of red blood cells, plasma, and platelets (all p values < 0.05). In a stepwise multiple analysis, the following characteristics remained independently associated with the use of CRRT: the MELD score OR 1.12 (95% CL: 1.07−1.16), p value < 0.001, and the preoperative value for blood urea nitrogen OR 1.016 (95% CL: 1.010−1.023), p value < 0.001. The early use of CRRT after OLT occurred at a low rate in this large cohort; however, it was associated with worse outcomes. Apart from the preoperative severity, repeated intraoperative hypotension episodes, which were likely modifiable or preventable, were associated with the increased use of CRRT and higher postoperative creatinine.
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Affiliation(s)
- Gennaro Martucci
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti e Terapia ad Alta Specializzazione), Via Tricomi 5, 90133 Palermo, Italy; (G.M.); (M.R.); (G.P.); (A.A.)
| | - Matteo Rossetti
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti e Terapia ad Alta Specializzazione), Via Tricomi 5, 90133 Palermo, Italy; (G.M.); (M.R.); (G.P.); (A.A.)
| | - Sergio Li Petri
- Abdominal Surgery and Organ Transplantation Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti e Terapia ad Alta Specializzazione), 90133 Palermo, Italy; (S.L.P.); (S.G.)
| | - Rossella Alduino
- Research Office, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti e Terapia ad Alta Specializzazione), 90133 Palermo, Italy;
| | - Riccardo Volpes
- Hepatology Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti e Terapia ad Alta Specializzazione), 90133 Palermo, Italy;
| | - Giovanna Panarello
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti e Terapia ad Alta Specializzazione), Via Tricomi 5, 90133 Palermo, Italy; (G.M.); (M.R.); (G.P.); (A.A.)
| | - Salvatore Gruttadauria
- Abdominal Surgery and Organ Transplantation Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti e Terapia ad Alta Specializzazione), 90133 Palermo, Italy; (S.L.P.); (S.G.)
| | - Gaetano Burgio
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti e Terapia ad Alta Specializzazione), Via Tricomi 5, 90133 Palermo, Italy; (G.M.); (M.R.); (G.P.); (A.A.)
- Correspondence: ; Tel./Fax: +39-091-21-92-111
| | - Antonio Arcadipane
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti e Terapia ad Alta Specializzazione), Via Tricomi 5, 90133 Palermo, Italy; (G.M.); (M.R.); (G.P.); (A.A.)
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[Kidney failure after liver transplantation]. Nephrol Ther 2022; 18:89-103. [PMID: 35151596 DOI: 10.1016/j.nephro.2021.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 05/11/2021] [Accepted: 11/06/2021] [Indexed: 02/06/2023]
Abstract
One third of cirrhotic patients present impaired kidney function. It has multifactorial causes and has a harmful effect on patients' morbi-mortality before and after liver transplant. Kidney function does not improve in all patients after liver transplantation and liver-transplant recipients are at high risk of developing chronic kidney disease. Causes for renal dysfunction can be divided in three groups: preoperative, peroperative and postoperative factors. To date, there is no consensus for the modality of evaluation the risk for chronic kidney disease after liver transplantation, and for its prevention. In the present review, we describe the outcome of kidney function after liver transplantation, and the prognostic factors of chronic kidney disease to determine a risk stratification for each patient. Furthermore, we discuss therapeutic options to prevent kidney dysfunction in this setting, and highlight the indications of combined liver-kidney transplantation.
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Abstract
One-third of patients with cirrhosis present kidney failure (AKI and CKD). It has multifactorial causes and a harmful effect on morbidity and mortality before and after liver transplantation. Kidney function does not improve in all patients after liver transplantation, and liver transplant recipients are at a high risk of developing chronic kidney disease. The causes of renal dysfunction can be divided into three groups: pre-operative, perioperative and post-operative factors. To date, there is no consensus on the modality to evaluate the risk of chronic kidney disease after liver transplantation, or for its prevention. In this narrative review, we describe the outcome of kidney function after liver transplantation, and the prognostic factors of chronic kidney disease in order to establish a risk categorization for each patient. Furthermore, we discuss therapeutic options to prevent kidney dysfunction in this context, and highlight the indications of combined liver–kidney transplantation.
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Ciria R, Gómez-Luque I, Cortés M, Khorsandi SE, Ayllón MD, Rodríguez-Perálvarez M, López-Cillero P, De La Mata M, O'Grady J, Heaton N, Briceño J. Interaction between tacrolimus, MELD score and acute kidney injury after liver transplantation. Analysis on a large contemporary bicenter meld-era series. Clin Transplant 2020; 34:e13890. [PMID: 32356404 DOI: 10.1111/ctr.13890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/18/2020] [Accepted: 04/26/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) after liver transplantation (LT) is a common problem with complex management. The aims were to analyze the profile of AKI-RIFLE categories in the post-transplant setting of a wide multicentre cohort of patients in the MELD era and to specifically determine the effect of tacrolimus-based (TACRO) immunosuppressive regimes on the development of AKI. METHODS A retrospective analysis of 550 (2007-2012) consecutive patients transplanted at Reina Sofia, Cordoba, and King's College Hospital, London, was performed. Inclusion criterion was to have CNI as part of initial immunosuppression immediately after LT. RESULTS After exclusion criteria, a total of 477 patients were analyzed. Incidence of AKI within the first 2 weeks after LT was 65.8% (AKI-Risk), 41.3% (AKI-Injury), and 12.3% (AKI-Failure). The development of any type of AKI had no impact on short- and/or long-term survival up to 3 years after the transplant. Moreover, AKI was almost universal in the early post-transplant period and TACRO trough concentrations during the first 2 weeks after the transplant were not predictors of AKI in none of its categories in the multivariate analyses. CONCLUSIONS Low-TACRO-based regimes were not as useful as expected in the prevention of AKI when analyzed in the context of a large contemporary LT series.
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Affiliation(s)
- Rubén Ciria
- Unit of Hepatobiliary Surgery and Liver Transplantation, IMIBIC, University Hospital Reina Sofía, University of Cordoba, Córdoba, Spain
| | - Irene Gómez-Luque
- Unit of Hepatobiliary Surgery and Liver Transplantation, IMIBIC, University Hospital Reina Sofía, University of Cordoba, Córdoba, Spain
| | - Miriam Cortés
- Institute of Liver Studies. King's College Hospital, King's Health Partners, London, UK
| | - Shirin E Khorsandi
- Institute of Liver Studies. King's College Hospital, King's Health Partners, London, UK
| | - Maria D Ayllón
- Unit of Hepatobiliary Surgery and Liver Transplantation, IMIBIC, University Hospital Reina Sofía, University of Cordoba, Córdoba, Spain
| | - Manuel Rodríguez-Perálvarez
- Unit of Hepatology and Liver Transplantation, CIBERehd, IMIBIC, University Hospital Reina Sofía, Córdoba, Spain
| | - Pedro López-Cillero
- Unit of Hepatobiliary Surgery and Liver Transplantation, IMIBIC, University Hospital Reina Sofía, University of Cordoba, Córdoba, Spain
| | - Manuel De La Mata
- Unit of Hepatology and Liver Transplantation, CIBERehd, IMIBIC, University Hospital Reina Sofía, Córdoba, Spain
| | - John O'Grady
- Institute of Liver Studies. King's College Hospital, King's Health Partners, London, UK
| | - Nigel Heaton
- Institute of Liver Studies. King's College Hospital, King's Health Partners, London, UK
| | - Javier Briceño
- Unit of Hepatobiliary Surgery and Liver Transplantation, IMIBIC, University Hospital Reina Sofía, University of Cordoba, Córdoba, Spain
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Faria LC, Andrade AMF, Trant CGMC, Lima AS, Machado PAB, Porto RD, Andrade MVM. Circulating levels of High‐mobility group box 1 protein and nucleosomes are associated with outcomes after liver transplant. Clin Transplant 2020; 34:e13869. [DOI: 10.1111/ctr.13869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 03/08/2020] [Accepted: 03/29/2020] [Indexed: 01/21/2023]
Affiliation(s)
- Luciana C. Faria
- Departamento de Clínica Médica Faculdade de Medicina Universidade Federal de Minas Gerais Belo Horizonte Brasil
- Grupo de Transplante de Órgãos Instituto Alfa de Gastroenterologia Hospital das Clínicas Universidade Federal de Minas Gerais Belo Horizonte Brasil
| | - Antônio Márcio F. Andrade
- Grupo de Transplante de Órgãos Instituto Alfa de Gastroenterologia Hospital das Clínicas Universidade Federal de Minas Gerais Belo Horizonte Brasil
| | - Cyntia G. M. C. Trant
- Laboratório de Fisiopatologia Cirúrgica Faculdade de Medicina Universidade Federal de Minas Gerais Belo Horizonte Brasil
| | - Agnaldo S. Lima
- Grupo de Transplante de Órgãos Instituto Alfa de Gastroenterologia Hospital das Clínicas Universidade Federal de Minas Gerais Belo Horizonte Brasil
- Departamento de Cirurgia Faculdade de Medicina Universidade Federal de Minas Gerais Belo Horizonte Brasil
| | - Pedro A. B. Machado
- Faculdade de Medicina Universidade Federal de Minas Gerais Belo Horizonte Brasil
| | - Rodrigo D. Porto
- Faculdade de Medicina Universidade Federal de Minas Gerais Belo Horizonte Brasil
| | - Marcus Vinícius M. Andrade
- Departamento de Clínica Médica Faculdade de Medicina Universidade Federal de Minas Gerais Belo Horizonte Brasil
- Laboratório de Fisiopatologia Cirúrgica Faculdade de Medicina Universidade Federal de Minas Gerais Belo Horizonte Brasil
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Kalisvaart M, Schlegel A, Umbro I, de Haan JE, Polak WG, IJzermans JN, Mirza DF, Perera MTP, Isaac JR, Ferguson J, Mitterhofer AP, de Jonge J, Muiesan P. The AKI Prediction Score: a new prediction model for acute kidney injury after liver transplantation. HPB (Oxford) 2019; 21:1707-1717. [PMID: 31153834 DOI: 10.1016/j.hpb.2019.04.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 03/29/2019] [Accepted: 04/08/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) is a frequent complication after liver transplantation. Although numerous risk factors for AKI have been identified, their cumulative impact remains unclear. Our aim was therefore to design a new model to predict post-transplant AKI. METHODS Risk analysis was performed in patients undergoing liver transplantation in two centres (n = 1230). A model to predict severe AKI was calculated, based on weight of donor and recipient risk factors in a multivariable regression analysis according to the Framingham risk-scheme. RESULTS Overall, 34% developed severe AKI, including 18% requiring postoperative renal replacement therapy (RRT). Five factors were identified as strongest predictors: donor and recipient BMI, DCD grafts, FFP requirements, and recipient warm ischemia time, leading to a range of 0-25 score points with an AUC of 0.70. Three risk classes were identified: low, intermediate and high-risk. Severe AKI was less frequently observed if recipients with an intermediate or high-risk were treated with a renal-sparing immunosuppression regimen (29 vs. 45%; p = 0.007). CONCLUSION The AKI Prediction Score is a new instrument to identify recipients at risk for severe post-transplant AKI. This score is readily available at end of the transplant procedure, as a tool to timely decide on the use of kidney-sparing immunosuppression and early RRT.
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Affiliation(s)
- Marit Kalisvaart
- The Liver Unit, Queen Elizabeth University Hospital, Birmingham, United Kingdom; Department of Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Andrea Schlegel
- The Liver Unit, Queen Elizabeth University Hospital, Birmingham, United Kingdom
| | - Ilaria Umbro
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, Rome, Italy; Department of Clinical Medicine, Nephrology Unit, Sapienza University of Rome, Rome, Italy
| | - Jubi E de Haan
- Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Wojciech G Polak
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Jan N IJzermans
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Darius F Mirza
- The Liver Unit, Queen Elizabeth University Hospital, Birmingham, United Kingdom
| | - M Thamara Pr Perera
- The Liver Unit, Queen Elizabeth University Hospital, Birmingham, United Kingdom
| | - John R Isaac
- The Liver Unit, Queen Elizabeth University Hospital, Birmingham, United Kingdom
| | - James Ferguson
- The Liver Unit, Queen Elizabeth University Hospital, Birmingham, United Kingdom
| | - Anna P Mitterhofer
- Department of Clinical Medicine, Nephrology Unit, Sapienza University of Rome, Rome, Italy
| | - Jeroen de Jonge
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Paolo Muiesan
- The Liver Unit, Queen Elizabeth University Hospital, Birmingham, United Kingdom.
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Ferah O, Akbulut A, Açik ME, Gökkaya Z, Acar U, Yenidünya Ö, Yentür E, Tokat Y. Acute Kidney Injury After Pediatric Liver Transplantation. Transplant Proc 2019; 51:2486-2491. [PMID: 31443924 DOI: 10.1016/j.transproceed.2019.01.179] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 01/28/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND The aim of the present study is to assess acute kidney injury (AKI) incidence according to the pRIFLE and AKIN criteria and to evaluate the risk factors for early developing AKI in postoperative intensive care unit after pediatric liver transplantation (LT). MATERIALS After exclusion of retransplantations, 7 cadaveric and 44 living donors, totaling 51 pediatric LT patients that were performed between 2005 and 2017, were reviewed retrospectively. AKI was defined according to both pediatric RIFLE (Risk for renal dysfunction, Injury to the kidney, Failure of kidney function, Loss of kidney function, and End-stage renal disease) and Acute Kidney Injury Network (AKIN) criteria. Documented data were compared between AKI and non-AKI patients. RESULTS AKI incidences were 17.6% by AKIN and 37.8% by pRIFLE criteria. AKIN-defined AKI group had statistically lower serum albumin level, higher serum sodium level, higher furosemide dose, and higher rate of red blood cell (RBC) transfusion than the non-AKI group (P = .02, P = .02, P = .01 and P = .04, respectively). AKI patients had significantly prolonged mechanical ventilation (P = .01) and hospital LOS (P = .02). The pRIFLE-defined AKI group had significantly lower serum albumin level, higher blood urea nitrogen (BUN) level, and higher ascites drained and also showed higher requirement for RBC and 20% human albumin transfusions than the non-AKI group (P = .02, P = .04, P: =.007, P = .02 and P = .05, respectively). CONCLUSION We evaluated that hypoalbuminemia, high requirement for RBC and 20% human albumin transfusions, high serum sodium, high furosemide use, and high flow of ascites are risk factors for AKI and high BUN levels can be predictive for AKI in pediatric LT patients. The effect of AKI on outcome variables were prolonged mechanical ventilation and hospital LOS.
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Affiliation(s)
- Oya Ferah
- Department of Anesthesiology and Reanimation, Surgical Intensive Care Unit, Şişli Florence Nightingale Hospital, Istanbul Bilim University, Istanbul, Turkey.
| | - Akin Akbulut
- Department of Anesthesiology, Koç University Hospital, Istanbul, Turkey
| | - Mehmet Eren Açik
- Department of Anesthesiology and Reanimation, Surgical Intensive Care Unit, Şişli Florence Nightingale Hospital, Istanbul Bilim University, Istanbul, Turkey
| | - Zafer Gökkaya
- Department of Anesthesiology and Reanimation, Surgical Intensive Care Unit, Şişli Florence Nightingale Hospital, Istanbul Bilim University, Istanbul, Turkey
| | - Umut Acar
- Department of Anesthesiology and Reanimation, Surgical Intensive Care Unit, Şişli Florence Nightingale Hospital, Istanbul Bilim University, Istanbul, Turkey
| | - Özlem Yenidünya
- Department of Anesthesiology and Reanimation, Surgical Intensive Care Unit, Şişli Florence Nightingale Hospital, Istanbul Bilim University, Istanbul, Turkey
| | - Ercüment Yentür
- Department of Anesthesiology and Reanimation, Surgical Intensive Care Unit, Şişli Florence Nightingale Hospital, Istanbul Bilim University, Istanbul, Turkey
| | - Yaman Tokat
- Department of Liver Transplantation, Şişli Florence Nightingale Hospital, Istanbul, Turkey
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Ali AY, William KY, Emad N, Mogawer MS, Elshazli MM, Youssof M, Zidan M. Effect of Duration of Intensive Care Unit Stay on Outcomes of Adult Living Donor Liver Transplant Recipients. Transplant Proc 2019; 51:2425-2429. [PMID: 31277908 DOI: 10.1016/j.transproceed.2019.03.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/10/2019] [Accepted: 03/23/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIM Acute kidney injury (AKI) is common in patients undergoing liver transplantation and is associated with reduced patient and graft survival. The aim is to assess the occurrence of AKI following living donor liver transplantation and to evaluate the associated risk factors and outcomes. SUBJECTS AND METHODS Forty-nine Egyptian patients with hepatitis C virus who underwent living donor liver transplantation were divided into Group A (17 patients with AKI defined as increased creatinine > 50% of the initial pretransplant level) and Group B (non-AKI patients). Fluid balance, kidney function, preoperative and intraoperative risk factors, outcomes, and 1-year mortality were assessed. RESULTS The mean age was 48 ± 7.51 and the majority of patients assessed were men (89.8%). The 17 patients with AKI had higher preoperative creatinine and higher Model for End-Stage Liver Disease scores (1.3 ± 0.16, 15.7 ± 5.07, respectively) than the non-AKI patients (1.1 ± .15, 13.7 ± 4.61, respectively), with P values of .04 and < .01, respectively. They also had significantly lower levels of albumin (2.98 ± .50). AKI patients had longer intensive care unit (ICU) stays (10 ± 3 d) compared to non-AKI patients (5 ± 2), with a P value of .03. A logistic multivariable regression test revealed that only a long ICU stay is a predictor of developing acute kidney injury among patients who have undergone living donor liver transplantation (odds ratio 1.23, 95% confidence interval 1.1-2.1, with a P value of .012). CONCLUSION Many pre- and intra-operative factors are associated with AKI development; however, a long ICU stay is an independent potential factor for kidney infection.
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Affiliation(s)
- Ahmed Y Ali
- Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Kerolis Y William
- Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nahla Emad
- Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed S Mogawer
- Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mostafa M Elshazli
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Maha Youssof
- Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mahmoud Zidan
- Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
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9
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Thongprayoon C, Kaewput W, Thamcharoen N, Bathini T, Watthanasuntorn K, Lertjitbanjong P, Sharma K, Salim SA, Ungprasert P, Wijarnpreecha K, Kröner PT, Aeddula NR, Mao MA, Cheungpasitporn W. Incidence and Impact of Acute Kidney Injury after Liver Transplantation: A Meta-Analysis. J Clin Med 2019; 8:372. [PMID: 30884912 PMCID: PMC6463182 DOI: 10.3390/jcm8030372] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 03/05/2019] [Accepted: 03/14/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The study's aim was to summarize the incidence and impacts of post-liver transplant (LTx) acute kidney injury (AKI) on outcomes after LTx. METHODS A literature search was performed using the MEDLINE, EMBASE and Cochrane Databases from inception until December 2018 to identify studies assessing the incidence of AKI (using a standard AKI definition) in adult patients undergoing LTx. Effect estimates from the individual studies were derived and consolidated utilizing random-effect, the generic inverse variance approach of DerSimonian and Laird. The protocol for this systematic review is registered with PROSPERO (no. CRD42018100664). RESULTS Thirty-eight cohort studies, with a total of 13,422 LTx patients, were enrolled. Overall, the pooled estimated incidence rates of post-LTx AKI and severe AKI requiring renal replacement therapy (RRT) were 40.7% (95% CI: 35.4%⁻46.2%) and 7.7% (95% CI: 5.1%⁻11.4%), respectively. Meta-regression showed that the year of study did not significantly affect the incidence of post-LTx AKI (p = 0.81). The pooled estimated in-hospital or 30-day mortality, and 1-year mortality rates of patients with post-LTx AKI were 16.5% (95% CI: 10.8%⁻24.3%) and 31.1% (95% CI: 22.4%⁻41.5%), respectively. Post-LTx AKI and severe AKI requiring RRT were associated with significantly higher mortality with pooled ORs of 2.96 (95% CI: 2.32⁻3.77) and 8.15 (95%CI: 4.52⁻14.69), respectively. Compared to those without post-LTx AKI, recipients with post-LTx AKI had significantly increased risk of liver graft failure and chronic kidney disease with pooled ORs of 3.76 (95% CI: 1.56⁻9.03) and 2.35 (95% CI: 1.53⁻3.61), respectively. CONCLUSION The overall estimated incidence rates of post-LTx AKI and severe AKI requiring RRT are 40.8% and 7.0%, respectively. There are significant associations of post-LTx AKI with increased mortality and graft failure after transplantation. Furthermore, the incidence of post-LTx AKI has remained stable over the ten years of the study.
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Affiliation(s)
- Charat Thongprayoon
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA.
| | - Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand.
| | - Natanong Thamcharoen
- Division of Nephrology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
| | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, AZ 85721, USA.
| | | | | | - Konika Sharma
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY 13326, USA.
| | - Sohail Abdul Salim
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, MS 39216, USA.
| | - Patompong Ungprasert
- Clinical Epidemiology Unit, Department of Research and Development, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
| | - Karn Wijarnpreecha
- Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL 32224, USA.
| | - Paul T Kröner
- Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL 32224, USA.
| | - Narothama Reddy Aeddula
- Division of Nephrology, Department of Medicine, Deaconess Health System, Evansville, IN 47747, USA.
| | - Michael A Mao
- Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL 32224, USA.
| | - Wisit Cheungpasitporn
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, MS 39216, USA.
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10
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Srivastava P, Agarwal A, Jha A, Rodricks S, Malik T, Makki K, Singhal A, Vij V. Utility of prothrombin complex concentrate as first-line treatment modality of coagulopathy in patients undergoing liver transplantation: A propensity score-matched study. Clin Transplant 2018; 32:e13435. [PMID: 30375084 DOI: 10.1111/ctr.13435] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/18/2018] [Accepted: 10/19/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Transfusion management during liver transplantation (LT) is aimed at reducing blood loss and allogeneic transfusion requirements. Although prothrombin complex concentrate (PCC) has been used satisfactorily in various bleeding disorders, studies on its safety, and efficacy during LT are limited. METHODS A retrospective chart review of adult patients who underwent living donor LT at a single institute between October 2016 and January 2018 was carried out. The safety and efficacy of PCC in reducing transfusion requirements intraoperatively in patients who received PCC were compared with patients who did not receive PCC. A propensity score-matching technique was used, at a 1:1 ratio, to remove selection bias. RESULTS After completing the 1:1 propensity score-matched analysis, 60 pairs of patients were identified. The use of PCC was associated with significantly decreased red blood cell transfusion requirements (6.2 ± 4.1 vs 8.23 ± 5.18, P < 0.001) and fresh frozen plasma transfusion requirements (2.6 ± 2 vs 6.18 ± 4.1, P < 0.001). The number of patients developing postoperative hemorrhagic complications was higher in the non-PCC group. CONCLUSIONS During LT, the use of PCC led to decreased transfusion requirements. No thromboembolic complications related to PCC were noted in this series.
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Affiliation(s)
- Piyush Srivastava
- Department of Liver Transplant Anaesthesia and Critical Care, Fortis Hospital, Noida, India
| | - Anil Agarwal
- Department of Liver Transplant Anaesthesia and Critical Care, Fortis Hospital, Noida, India
| | - Amit Jha
- Department of Liver Transplant Anaesthesia and Critical Care, Fortis Hospital, Noida, India
| | - Suvyl Rodricks
- Department of Liver Transplant Anaesthesia and Critical Care, Fortis Hospital, Noida, India
| | - Tanuja Malik
- Department of Liver Transplant Anaesthesia and Critical Care, Fortis Hospital, Noida, India
| | - Kausar Makki
- Department of Liver Transplant and HPB Surgery, Fortis Hospital, Noida, India
| | - Ashish Singhal
- Department of Liver Transplant and HPB Surgery, Fortis Hospital, Noida, India
| | - Vivek Vij
- Department of Liver Transplant and HPB Surgery, Fortis Hospital, Noida, India
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11
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Qu B, Yu F, Sheng GN, Zhang W, Zhang YM, Deng YL, Shi Y, Shen ZY. Protective Effect of a Novel Technique for Liver Transplantation in the Rat. Transplant Proc 2018; 50:267-273. [PMID: 29407321 DOI: 10.1016/j.transproceed.2017.12.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 11/26/2017] [Accepted: 12/12/2017] [Indexed: 11/27/2022]
Abstract
The rat orthotopic liver transplantation model with extremely short anhepatic phase was established to study its protective effect on the recipients and graft. One hundred fifty adult male Wistar rats were randomly divided into three groups: group A (n = 30), using magnetic rings for the suprahepatic vena cava reconstruction; group B (n = 30), using 7/0 Prolene sutures for suprahepatic vena cava running anastomosis as control; and a sham-operated group (n = 30) as a blank control group. The changes in liver enzyme, serum creatinine, endotoxin, and cytokine levels and histopathology were recorded. The serum creatinine, potassium, alanine transaminase, and alkaline phosphatase levels at different points in time in group A were lower than those in group B (P < .05). The level of portal vein blood endotoxin in group A was significantly lower than that in group B at each point (P < .01). At the same time, all the cytokines in group B were higher than those in group A, and the two groups were higher than those in the sham operation group. The mean levels of tumor necrosis factor-α (TNF-α), interferon-γ, (IFN-γ), and interleukin-1ß (IL-1ß) at 3 hours were higher than at 6 hours in group A. IL-10 and tissue inhibitor of metalloproteinase-1 (TIMP-1) were all higher at 3 hours in groups A and B. Levels of monocyte chemotactic protein-1, L-selectin, and TIMP-1 in group A and IL-10, monocyte chemotactic protein-1, L-selectin, and TIMP-1 in group B were higher in blood than in the liver. Levels of TNF-α, IFN-γ, IL-1, IL-10, and intracellular adhesion molecule-1 in group A and TNF-α, IFN-γ IL-1ß, and intracellular adhesion molecule-1 in group B were higher in the liver than in blood. We conclude that the extremely short anhepatic phase has protective effects on recipients and grafts in rat liver transplantation because it is related to alleviating ischemia-reperfusion injury and reducing the endotoxin release.
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Affiliation(s)
- B Qu
- Department of Oncological Surgery, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Logistics University of Chinese People's Armed Police Forces, Tianjin, China
| | - F Yu
- Department of Emergency, the Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
| | - G-N Sheng
- Organ Transplantation Center, Tianjin First Center Hospital, Nankai District, Tianjin, China
| | - W Zhang
- Organ Transplantation Center, Tianjin First Center Hospital, Nankai District, Tianjin, China
| | - Y-M Zhang
- Organ Transplantation Center, Tianjin First Center Hospital, Nankai District, Tianjin, China
| | - Y-L Deng
- Organ Transplantation Center, Tianjin First Center Hospital, Nankai District, Tianjin, China
| | - Y Shi
- Organ Transplantation Center, Tianjin First Center Hospital, Nankai District, Tianjin, China.
| | - Z-Y Shen
- Organ Transplantation Center, Tianjin First Center Hospital, Nankai District, Tianjin, China
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12
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Fiacco F, Melandro F, Umbro I, Zavatto A, Cappoli A, Poli E, Ginanni Corradini S, Merli M, Tinti F, Nofroni I, Berloco PB, Rossi M, Mitterhofer AP. Fluctuations of Estimated Glomerular Filtration Rate Outside Kidney Disease Improving Global Outcomes Diagnostic Criteria for Acute Kidney Injury in End-Stage Liver Disease Outpatients and Outcome Postliver Transplantation. Transplant Direct 2018; 4:e222. [PMID: 29399624 PMCID: PMC5777666 DOI: 10.1097/txd.0000000000000733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 08/03/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Renal dysfunction in end-stage liver disease (ESLD) results from systemic conditions that affect both liver and kidney with activation of vasoconstrictor systems. In this setting, estimated glomerular filtration rate (eGFR) may undergo variations often outside Kidney Disease Improving Global Outcomes criteria for acute kidney injury (AKI) diagnosis, whose meaning is not clear. The aim of this study was to evaluate eGFR variations in ESLD outpatients listed for liver transplant (liver Tx) and the association with post-Tx outcome. METHODS Fifty-one patients with ESLD were retrospectively evaluated from listing to transplant (L-Tx time), intraoperatively (Tx time), and up to 5 years post-Tx time. Variations between the highest and the lowest eGFR occurring in more than 48 hours, not satisfying Kidney Disease Improving Global Outcomes guideline, were considered as fluctuations (eGFR-F). Fluctuations of eGFR greater than 50% were defined as eGFR drops (DeGFR). Early graft dysfunction, AKI within 7 days, chronic kidney disease, and short- and long-term patient survivals were considered as outcomes. RESULTS All patients presented eGFR-F, whereas DeGFR were observed in 18 (35.3%) of 51 (DeGFR+ group). These patients presented higher levels of Model for End-stage Liver Disease score, pre-Tx bilirubin and significantly greater incidence of post-Tx AKI stages 2 to 3 compared with patients without drops (DeGFR-). DeGFR was the only independent predictive factor of the occurrence of post-Tx AKI. The occurrence of AKI post-Tx was associated with the development of chronic kidney disease at 3 months and 5 years post-Tx. CONCLUSIONS Drops of eGFR are more frequently observed in patients with a worse degree of ESLD and are associated with a worse post-Tx kidney outcome.
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Affiliation(s)
- Federica Fiacco
- Nephrology Unit, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Fabio Melandro
- Organ Transplant Unit, Department of General Surgery, Sapienza University of Rome, Rome, Italy
| | - Ilaria Umbro
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, Rome, Italy
| | - Assunta Zavatto
- Nephrology Unit, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Andrea Cappoli
- Nephrology Unit, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Edoardo Poli
- Gastroenterology Unit, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Manuela Merli
- Gastroenterology Unit, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Francesca Tinti
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, Rome, Italy
| | - Italo Nofroni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Pasquale B. Berloco
- Organ Transplant Unit, Department of General Surgery, Sapienza University of Rome, Rome, Italy
| | - Massimo Rossi
- Organ Transplant Unit, Department of General Surgery, Sapienza University of Rome, Rome, Italy
| | - Anna Paola Mitterhofer
- Nephrology Unit, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
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13
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Kalisvaart M, de Haan JE, Hesselink DA, Polak WG, Hansen BE, IJzermans JNM, Gommers D, Metselaar HJ, de Jonge J. The postreperfusion syndrome is associated with acute kidney injury following donation after brain death liver transplantation. Transpl Int 2017; 30:660-669. [DOI: 10.1111/tri.12891] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 07/28/2016] [Accepted: 11/11/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Marit Kalisvaart
- Department of Surgery; Erasmus MC University Medical Center; Rotterdam The Netherlands
| | - Jubi E. de Haan
- Department of Adult Intensive Care; Erasmus MC University Medical Center; Rotterdam The Netherlands
| | - Dennis A. Hesselink
- Department of Internal Medicine; Erasmus MC University Medical Center; Rotterdam The Netherlands
| | - Wojciech G. Polak
- Department of Surgery; Erasmus MC University Medical Center; Rotterdam The Netherlands
| | - Bettina E. Hansen
- Department of Gastroenterology and Hepatology; Erasmus MC University Medical Center; Rotterdam The Netherlands
| | - Jan N. M. IJzermans
- Department of Surgery; Erasmus MC University Medical Center; Rotterdam The Netherlands
| | - Diederik Gommers
- Department of Adult Intensive Care; Erasmus MC University Medical Center; Rotterdam The Netherlands
| | - Herold J. Metselaar
- Department of Gastroenterology and Hepatology; Erasmus MC University Medical Center; Rotterdam The Netherlands
| | - Jeroen de Jonge
- Department of Surgery; Erasmus MC University Medical Center; Rotterdam The Netherlands
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14
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Risk factors of acute kidney injury after orthotopic liver transplantation in China. Sci Rep 2017; 7:41555. [PMID: 28134286 PMCID: PMC5278509 DOI: 10.1038/srep41555] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 12/21/2016] [Indexed: 12/17/2022] Open
Abstract
In this study, we determined the risk factors for acute kidney injury (AKI) following orthotopic liver transplantation (OLT) in China. We collected 5074 donation after cardiac death (DCD) OLT recipients who underwent surgery between January 1, 2010, and December 31, 2015, in 86 academic hospitals or transplant centers in China. Univariate and multivariate analyses were used to investigate the criticality of donor, graft, or recipient variables in the development of post-OLT AKI. In all, 4482 patients were included (median age, 49.31 years). Post-OLT AKI occurred in 3.97% patients, and 73.6% of all OLT patients were male. The 1- and 5-year cumulative survival rates (CSRs) of the AKI group were 33.95% and 25.24%, respectively, compared with 86.34% and 70.05%, respectively, of the non-AKI group (P < 0.001). The independent risk factors for post-OLT AKI were blood loss, cold ischemia time, warm ischemia time, preoperative serum creatinine, the treatment period with dopamine, overexposure to calcineurin inhibitor, and combined mycophenolate mofetil use (P < 0.05). These had a high prediction accuracy for post-OLT AKI (area under the curve [AUC] = 0.740).
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15
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Umbro I, Tinti F, Scalera I, Evison F, Gunson B, Sharif A, Ferguson J, Muiesan P, Mitterhofer AP. Acute kidney injury and post-reperfusion syndrome in liver transplantation. World J Gastroenterol 2016; 22:9314-9323. [PMID: 27895419 PMCID: PMC5107695 DOI: 10.3748/wjg.v22.i42.9314] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/10/2016] [Accepted: 09/28/2016] [Indexed: 02/06/2023] Open
Abstract
In the past decades liver transplantation (LT) has become the treatment of choice for patients with end stage liver disease (ESLD). The chronic shortage of cadaveric organs for transplantation led to the utilization of a greater number of marginal donors such as older donors or donors after circulatory death (DCD). The improved survival of transplanted patients has increased the frequency of long-term complications, in particular chronic kidney disease (CKD). Acute kidney injury (AKI) post-LT has been recently recognized as an important risk factor for the occurrence of de novo CKD in the long-term outcome. The onset of AKI post-LT is multifactorial, with pre-LT risk factors involved, including higher Model for End-stage Liver Disease score, more sever ESLD and pre-existing renal dysfunction, either with intra-operative conditions, in particular ischaemia reperfusion injury responsible for post-reperfusion syndrome (PRS) that can influence recipient’s morbidity and mortality. Post-reperfusion syndrome-induced AKI is an important complication post-LT that characterizes kidney involvement caused by PRS with mechanisms not clearly understood and implication on graft and patient survival. Since pre-LT risk factors may influence intra-operative events responsible for PRS-induced AKI, we aim to consider all the relevant aspects involved in PRS-induced AKI in the setting of LT and to identify all studies that better clarified the specific mechanisms linking PRS and AKI. A PubMed search was conducted using the terms liver transplantation AND acute kidney injury; liver transplantation AND post-reperfusion syndrome; acute kidney injury AND post-reperfusion syndrome; acute kidney injury AND DCD AND liver transplantation. Five hundred seventy four articles were retrieved on PubMed search. Results were limited to title/abstract of English-language articles published between 2000 and 2015. Twenty-three studies were identified that specifically evaluated incidence, risk factors and outcome for patients developing PRS-induced AKI in liver transplantation. In order to identify intra-operative risk factors/mechanisms specifically involved in PRS-induced AKI, avoiding confounding factors, we have limited our study to “acute kidney injury AND DCD AND liver transplantation”. Accordingly, three out of five studies were selected for our purpose.
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16
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Zongyi Y, Baifeng L, Funian Z, Hao L, Xin W. WITHDRAWN: Risk factors of acute kidney injury after orthotopic liver transplantation in China. EBioMedicine 2016:S2352-3964(16)30357-7. [PMID: 27543153 DOI: 10.1016/j.ebiom.2016.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 07/28/2016] [Accepted: 08/04/2016] [Indexed: 12/07/2022] Open
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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Affiliation(s)
- Yin Zongyi
- Department of hepatobiliary surgery and organ transplantation, the First Hospital of China Medical University, Shenyang 110001, China
| | - Li Baifeng
- Department of hepatobiliary surgery and organ transplantation, the First Hospital of China Medical University, Shenyang 110001, China.
| | - Zou Funian
- Department of hepatobiliary surgery and organ transplantation, the First Hospital of China Medical University, Shenyang 110001, China
| | - Li Hao
- Department of hepatobiliary surgery and organ transplantation, the First Hospital of China Medical University, Shenyang 110001, China
| | - Wang Xin
- Department of hepatobiliary surgery and organ transplantation, the First Hospital of China Medical University, Shenyang 110001, China
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17
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Wiesen P, Massion PB, Joris J, Detry O, Damas P. Incidence and risk factors for early renal dysfunction after liver transplantation. World J Transplant 2016; 6:220-232. [PMID: 27011921 PMCID: PMC4801799 DOI: 10.5500/wjt.v6.i1.220] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 10/20/2015] [Accepted: 12/18/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine renal dysfunction post liver transplantation, its incidence and risk factors in patients from a Belgian University Hospital.
METHODS: Orthotopic liver transplantations performed from January 2006 until September 2012 were retrospectively reviewed (n = 187). Patients with no renal replacement therapy (RRT) before transplantation were classified into four groups according to their highest creatinine plasma level during the first postoperative week. The first group had a peak creatinine level below 12 mg/L, the second group between 12 and 20 mg/L, the third group between 20 and 35 mg/L, and the fourth above 35 mg/L. In addition, patients who needed RRT during the first week after transplantation were also classified into the fourth group. Perioperative parameters were recorded as risk factors, namely age, sex, body mass index (BMI), length of preoperative hospital stay, prior bacterial infection within one month, preoperative ascites, preoperative treatment with β-blocker, angiotensin-converting enzyme inhibitor or non steroidal anti-inflammatory drugs, preoperative creatinine and bilirubin levels, donor status (cardiac death or brain death), postoperative lactate level, need for intraoperative vasopressive drugs, surgical revision, mechanical ventilation for more than 24 h, postoperative bilirubin and transaminase peak levels, postoperative hemoglobin level, amount of perioperative blood transfusions and type of immunosuppression. Univariate and multivariate analysis were performed using logistic ordinal regression method. Post hoc analysis of the hemostatic agent used was also done.
RESULTS: There were 78 patients in group 1 (41.7%), 46 in group 2 (24.6%), 38 in group 3 (20.3%) and 25 in group 4 (13.4%). Twenty patients required RRT: 13 (7%) during the first week after transplantation. Using univariate analysis, the severity of renal dysfunction was correlated with presence of ascites and prior bacterial infection, preoperative bilirubin, urea and creatinine level, need for surgical revision, use of vasopressor, postoperative mechanical ventilation, postoperative bilirubin and urea, aspartate aminotransferase (ASAT), and hemoglobin levels and the need for transfusion. The multivariate analysis showed that BMI (OR = 1.1, P = 0.004), preoperative creatinine level (OR = 11.1, P < 0.0001), use of vasopressor (OR = 3.31, P = 0.0002), maximal postoperative bilirubin level (OR = 1.44, P = 0.044) and minimal postoperative hemoglobin level (OR = 0.059, P = 0.0005) were independent predictors of early post-liver transplantation renal dysfunction. Neither donor status nor ASAT levels had significant impact on early postoperative renal dysfunction in multivariate analysis. Absence of renal dysfunction (group 1) was also predicted by the intraoperative hemostatic agent used, independently of the extent of bleeding and of the preoperative creatinine level.
CONCLUSION: More than half of receivers experienced some degree of early renal dysfunction after liver transplantation. Main predictors were preoperative renal dysfunction, postoperative anemia and vasopressor requirement.
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18
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Karapanagiotou A, Dimitriadis C, Papadopoulos S, Kydona C, Kefsenidis S, Papanikolaou V, Gritsi-Gerogianni N. Comparison of RIFLE and AKIN criteria in the evaluation of the frequency of acute kidney injury in post-liver transplantation patients. Transplant Proc 2015; 46:3222-7. [PMID: 25420865 DOI: 10.1016/j.transproceed.2014.09.161] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Acute renal dysfunction is presented quite often after orthotopic liver transplantation (LT), with a reported incidence of 12-64%. The "RIFLE" criteria were introduced in 2004 for the definition of acute kidney injury (AKI) in critically ill patients, and a revised definition was proposed in 2007 by the Acute Kidney Injury Network (AKIN), introducing the AKIN criteria. The aim of this study was to record the incidence of AKI in patients after LT by both classifications and to evaluate their prognostic value on mortality. METHODS We retrospectively evaluated the records of patients with LT over 2 years (2011-2012) and recorded the incidence of AKI as defined by the RIFLE and AKIN criteria. Preoperative and admission severity of disease scores, duration of mechanical ventilation, intensive care unit length of stay, and 30- and 180-day survivals were also recorded. RESULTS Seventy-one patients were included, with an average age of 51.78 ± 10.3 years. The incidence of AKI according to the RIFLE criteria was 39.43% (Risk, 12.7%; Injury, 12.7%; Failure, 14.1%), whereas according to the AKIN criteria it was 52.1% (stage I, 22.5%; stage II, 7%; stage II 22.55%). AKI, regardless of the classification used, was related to the Model for End-Stage Liver Disease score, the volume of transfusions, the duration of mechanical ventilation, and survival. The presence of AKI was related to higher mortality, which rose proportionally with the severity of AKI as defined by the stages of either the RIFLE or the AKIN criteria. CONCLUSIONS AKI classifications according to the RIFLE and AKIN criteria are useful tools in the recognition and classification of the severity of renal dysfunction in patients after LT, because they are associated with higher mortality, which rises proportionally with the severity of renal disease.
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Affiliation(s)
- A Karapanagiotou
- Intensive Care Unit, "Hippokratio" Hospital, Thessaloniki, Greece.
| | - C Dimitriadis
- Department of Nephrology, "Hippokratio" Hospital, Thessaloniki, Greece
| | - S Papadopoulos
- Intensive Care Unit, "Hippokratio" Hospital, Thessaloniki, Greece
| | - C Kydona
- Intensive Care Unit, "Hippokratio" Hospital, Thessaloniki, Greece
| | - S Kefsenidis
- Intensive Care Unit, "Hippokratio" Hospital, Thessaloniki, Greece
| | - V Papanikolaou
- Department of Surgery and Transplantation, "Hippokratio" Hospital, Thessaloniki, Greece
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19
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Sirivatanauksorn Y, Parakonthun T, Premasathian N, Limsrichamrern S, Mahawithitwong P, Kositamongkol P, Tovikkai C, Asavakarn S. Renal Dysfunction After Orthotopic Liver Transplantation. Transplant Proc 2014; 46:818-21. [DOI: 10.1016/j.transproceed.2013.11.124] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 11/07/2013] [Indexed: 10/25/2022]
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20
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Naik P, Premsagar B, Mallikarjuna M. Acute renal failure in liver transplant patients: Indian study. Indian J Clin Biochem 2013; 30:94-8. [PMID: 25646048 DOI: 10.1007/s12291-013-0410-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 11/11/2013] [Indexed: 12/14/2022]
Abstract
The acute renal failure is the frequent medical complication observed in liver transplant patients. The objective of this study was to determine the cause of acute renal failure in post liver transplant patients. A total of 70 patients who underwent (cadaveric 52, live 18) liver transplantation were categorized based on clinical presentation into two groups, namely hepatorenal failure (HRF, n = 29), and Hepatic failure (HF, n = 41). All the patients after the liver transplant had received tacrolimus, mycophenolate and steroids. We analyzed the modification of diet in renal disease, (MDRD) serum urea, creatinine and albumin before and after 5th and 30th day of liver transplant and data was categorized into survivors and non-survivors group. In HRF survivor group, serum creatinine, and urea levels were high and, albumin, MDRD were low in pre- transplant and reached to normal levels on 30th day of post transplant, and 79.3 % of patients in this group showed resumption of normal kidney function. On the contrary in HRF nonsurvivor group, we did not observed any significant difference and 20.7 % of patients showed irreversible changes after the liver transplant. In HF survivor group, 82.9 % of liver failure patients did not show any deviation in serum creatinine, urea, albumin and MDRD, whereas in HF non survivor group, 17.1 % of liver failure patients who had HCV positive before the transplant developed acute renal failure. The levels of creatinine, urea, albumin and MDRD were normal before the transplant and on day 30th, the levels of albumin and MDRD were significantly low whereas serum urea, creatinine levels were high. In conclusion, based on these observations, an diagnosis and treatment of Acute renal failure is important among the liver transplantation cases in the early postoperative period.
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Affiliation(s)
- Pradeep Naik
- Department of Clinical Biochemistry, Global Hospitals, Lakdikapool, Hyderabad, 500004 India
| | - B Premsagar
- Department of Clinical Biochemistry, Global Hospitals, Lakdikapool, Hyderabad, 500004 India
| | - M Mallikarjuna
- Department of Clinical Biochemistry, Global Hospitals, Lakdikapool, Hyderabad, 500004 India
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Abstract
Acute kidney injury (AKI), one of the most frequent complications in the early period after liver transplantation, causes serious obstacles in the management of these patients affecting their outcomes. We studied retrospectively 79 subjects who underwent orthotopic liver transplantation (OLT). AKI was defined as an elevation of serum creatinine 1.5 times above baseline or an absolute serum creatinine level > 2 mg/dL. Our aim was to analyze the incidence, correlation with prior renal impairment, outcomes of AKI after OLT. Twenty-two patients (29.3%) developed AKI after OLT with 31.81% of the requiring renal replacement therapy. Among patients with AKI the duration of mechanical ventilation was prolonged (P = .001), length of stay in the intensive care unit was greater (P = .001), infections were more common (P = .016), and 30-day and 1-year mortality rates higher (P = .018). Logistic regression analysis showed post-OLT AKI to be an independent risk factor for 1-year mortality after OLT.
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22
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Lim KBL, Schiano TD. Long-term outcome after liver transplantation. ACTA ACUST UNITED AC 2012; 79:169-89. [PMID: 22499489 DOI: 10.1002/msj.21302] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Liver transplantation is a life-saving therapy for patients with end-stage liver disease, acute liver failure, and liver tumors. Over the past 4 decades, improvements in surgical techniques, peritransplant intensive care, and immunosuppressive regimens have resulted in significant improvements in short-term survival. Focus has now shifted to addressing long-term complications and improving quality of life in liver recipients. These include adverse effects of immunosuppression; recurrence of the primary liver disease; and management of diabetes, hypertension, dyslipidemia, obesity, metabolic syndrome, cardiovascular disease, renal dysfunction, osteoporosis, and de novo malignancy. Issues such as posttransplant depression, employment, sexual function, fertility, and pregnancy must not be overlooked, as they have a direct impact on the liver recipient's quality of life. This review summarizes the latest data in long-term outcome after liver transplantation.
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23
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Alonso Menárguez B, Gajate Martín L, García Suárez J, Martín Martín A, Moreno Ballesteros R, Arribas Pérez P, García Fernández J. [Retrospective comparative study between sevoflurane and propofol in maintaining anaesthesia during liver transplant: Effects on kidney and liver function]. ACTA ACUST UNITED AC 2012; 59:237-43. [PMID: 22560461 DOI: 10.1016/j.redar.2012.03.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 02/10/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the post-operative effects of sevoflurane versus propofol on liver and kidney function while maintaining anaesthesia in the orthotopic liver transplant (OLT), as well as to analyse the short-term survival as regards these functions. PATIENTS AND METHODS A retrospective analysis was conducted on patients subjected to an OLT between January 2002 and December 2009. Patients on pre-transplant haemodialysis, re-transplants, and hepatorenal transplants were excluded. The incidence of acute renal failure, initial dysfunction of the graft, reperfusion syndrome, rejection, and the transaminase peak depending value depending on the hypnotic used, were recorded. RESULTS About one-third (31.2%) of the patients developed acute renal failure and 11.9% an initial dysfunction, with no differences between the groups. There was a tendency for a lower incidence of initial dysfunction of the graft in the sevoflurane group (8.6% compared to 12.8%), a lower transaminase peak (greater than 2000 U/L, 12.1% versus 15.9%), and a lower incidence of reperfusion syndrome (10.3% compared to 21.6%). CONCLUSIONS Despite the fact that the renal metabolism sevoflurane is elevated, we did not find any higher incidence of acute renal failure. Sevoflurane in the liver transplant anaesthesia is as least equally as safe propofol as regards renal function and liver function. New prospective studies are needed to clarify the possible effects of the hypnotic in liver transplant.
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Affiliation(s)
- B Alonso Menárguez
- Servicio de Anestestesiología y Reanimación, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, España
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Levesque E, Hoti E, Azoulay D, Adam R, Samuel D, Castaing D, Saliba F. Non-invasive ICG-clearance: a useful tool for the management of hepatic artery thrombosis following liver transplantation. Clin Transplant 2011; 25:297-301. [PMID: 20412097 DOI: 10.1111/j.1399-0012.2010.01252.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The clinical presentation of hepatic artery thrombosis (HAT) post-liver transplantation (LT) varies considerably. Doppler ultrasonography (Doppler US) is the first line investigation, with a diagnostic sensitivity for HAT as high as 92%. Because indocyanine green (ICG) elimination from the blood depends among other factors on the hepatic blood flow, we hypothesized that plasma disappearance rate of indocyanine green (PDR-ICG) can be influenced by the flow in the hepatic artery. Thus, we evaluated the role of PDR-ICG measurement in HAT diagnosis in post-LT patients. PATIENTS AND METHODS Fourteen liver transplant patients with no visible flow in the hepatic artery (Doppler US) were identified. Of the 14, seven patients had HAT confirmed by CT-angiography. The PDR-ICG measurement, an investigation routinely used in our center, was performed in all 14 patients. RESULTS The PDR-ICG in patients with HAT was significantly lower than in patients without HAT (5.8 ± 4.3 vs. 23.8 ± 7.4%/min, p= 0.0009). In patients with HAT, after the revascularization, the PDR-ICG value increased (5.8 ± 4.3 vs. 15.6 ± 3.5%/min, p = 0.006). CONCLUSION The ICG elimination may be an adjunct diagnostic tool in the management of patients with suspected HAT following LT.
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Affiliation(s)
- E Levesque
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France
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25
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Zand MS, Orloff MS, Abt P, Patel S, Tsoulfas G, Kashyap R, Jain A, Safadjou S, Bozorgzadeh A. High mortality in orthotopic liver transplant recipients who require hemodialysis. Clin Transplant 2011; 25:213-221. [PMID: 20331690 DOI: 10.1111/j.1399-0012.2010.01238.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Acute renal failure is a significant risk factor for death in patients with liver failure. The goal of this study was to analyze the impact of peri-transplant dialysis on the long-term mortality of liver transplant recipients. We performed a single-center, retrospective cohort study of 743 adult liver transplants; patients who received first liver transplants were divided into four groups: those who received more than one dialysis treatment (hemodialysis [HD], continuous veno-venous hemodialysis [CVVH]) pre-orthotopic liver transplantation (OLT), post OLT, pre- and post OLT, and those not dialyzed. There was no statistically significant difference in the mean survival time for patients who were not dialyzed or dialyzed only pre-OLT. Mean survival times were markedly reduced in patients dialyzed post OLT or both pre- and post OLT compared with those never dialyzed. Mortality risk in a Cox proportional hazards model correlated with hemodialysis post OLT, intra-operative vasopressin or neosynephrine, donor age >50 yr, Cr >1.5 mg/dL at transplant, and need for subsequent retransplant. Risk of post-OLT dialysis was correlated with pre-OLT dialysis, intra-operative levophed, pre-OLT diabetes, African American race, pre-OLT Cr >1.5, and male gender. We conclude that renal failure requiring hemodialysis post liver transplant, irrespective of pre-transplant dialysis status, is a profound risk factor for death in liver transplant recipients.
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Affiliation(s)
- Martin S Zand
- Division of Nephrology, University of Rochester Medical Center, Rochester, NY 14642, USA.
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26
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Mehrabi A, Fonouni H, Ayoub E, Rahbari NN, Müller SA, Morath C, Seckinger J, Sadeghi M, Golriz M, Esmaeilzadeh M, Hillebrand N, Weitz J, Zeier M, Büchler MW, Schmidt J, Schmied BM. A single center experience of combined liver kidney transplantation. Clin Transplant 2010; 23 Suppl 21:102-14. [PMID: 19930323 DOI: 10.1111/j.1399-0012.2009.01146.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
With advancements in the operative techniques, patient survival following liver transplantation (LTx) has increased substantially. This has led to the acceleration of pre-existing kidney disease because of immunosuppressive nephrotoxicity making additional kidney transplantation (KTx) inevitable. On the other hand, in a growing number of patients on the waiting list to receive liver, long waiting time has resulted in adverse effect of decompensated liver on the kidney function. During the last two decades, the transplant community has considered combined liver kidney transplantation (CLKTx) to overcome this problem. The aim of our study is to present an overview of our experience as well as a review of the literature in CLKTx and to discuss the controversy in this regard. All performed CLKTx (n = 22) at our institution as well as all available reported case series focusing on CLKTx are extracted. The references of the manuscripts were cross-checked to implement further articles into the review. The analyzed parameters include demographic data, indication for LTx and KTx, duration on the waiting list, Model for End-Stage Liver Disease (MELD) score, Child-Turcotte-Pugh (CTP) score, immunosuppressive regimen, post-transplant complications, graft and patient survival, and cause of death. From 1988 to 2009, a total of 22 CLKTx were performed at our institution. The median age of the patients at the time of CLKTx was 44.8 (range: 4.5-58.3 yr). The indications for LTx were liver cirrhosis, hyperoxaluria type 1, polycystic liver disease, primary or secondary sclerosing cholangitis, malignant hepatic epithelioid hemangioendothelioma, cystinosis, and congenital biliary fibrosis. The KTx indications were end-stage renal disease of various causes, hyperoxaluria type 1, polycystic kidney disease, and cystinosis. The mean follow-up duration for CLKTx patients were 4.6 +/- 3.5 yr (range: 0.5-12 yr). Overall, the most important encountered complications were sepsis (n = 8), liver failure leading to retransplantation (n = 4), liver rejection (n = 3), and kidney rejection (n = 1). The overall patient survival rate was 80%. Review of the literature showed that from 1984 to 2008, 3536 CLKTx cases were reported. The main indications for CLKTx were oxalosis of both organs, liver cirrhosis and chronic renal failure, polycystic liver and kidney disease, and liver cirrhosis along with hepatorenal syndrome (HRS). The most common encountered complications following CLKTx were infection, bleeding, biliary complications, retransplantation of the liver, acute hepatic artery thrombosis, and retransplantation of the kidney. From the available data regarding the need for post-operative dialysis (n = 673), a total of 175 recipients (26%) required hemodialysis. During the follow-up period, 154 episodes of liver rejection (4.3%) and 113 episodes of kidney rejection (3.2%) occurred. The cumulative 1, 2, 3, and 5 yr survival of both organs were 78.2%, 74.4%, 62.4%, and 60.9%, respectively. Additionally, the cumulative 1, 2, 3, and 5 yr patient survival were 84.9%, 52.8%, 45.4%, and 42.6%, respectively. The total number of reported deaths was 181 of 2808 cases (6.4%), from them the cause of death in 99 (55%) cases was sepsis. It can be concluded that there is still no definitive evidence of better graft and patient survival in CLKTx recipients when compared with LTx alone because of the complexity of the exact definition of irreversible kidney function in LTx candidates. Additionally, CLKTx is better to be performed earlier than isolated LTx and KTx leading to the avoidance of deterioration of clinical status, high rate of graft loss, and mortality. Shorter graft ischemia time and more effective immunosuppressive regimens can reduce the incidence of graft malfunctioning in CLKTx patients. Providing a model to reliably determine the need for CLKTx seems necessary. Such a model can be shaped based upon new and precise markers of renal function, and modification of MELD system.
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Affiliation(s)
- A Mehrabi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
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27
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Rymarz A, Serwacki M, Rutkowski M, Pakosiński K, Grodzicki M, Patkowski W, Kacka A, Ołdakowska-Jedynak U, Krawczyk M. Prevalence and predictors of acute renal injury in liver transplant recipients. Transplant Proc 2010; 41:3123-5. [PMID: 19857692 DOI: 10.1016/j.transproceed.2009.08.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Renal failure is a major factor impacting liver transplant outcomes. Renal functional impairment predicts decreased survival, leading to increased morbidity and mortality. The aim of this study was to estimate the incidence, risk factors, and resolution of acute kidney injury (AKI) among liver transplant recipients during the operative hospital stay. We analyzed data from 99 orthotopic liver transplantations (OLT) performed at our center in 2008. Posttransplantation occurrence of AKI was defined as an increase in serum creatinine (SCr) concentration of 0.3 mg/dL or more, namely, 1.5-fold from baseline. AKI was observed among 31.31% of liver transplant recipients (n = 31). The mean increase in SCr was 2.49 +/- 0.78-fold from baseline. The mean posttransplant SCr level was 2.59 +/- 0.92 mg/dL. Renal replacement therapy was introduced to 16.12% (n = 5) liver recipients developing AKI. Among them, 2 subjects (6.45%) died. The mean SCr level at the time of discharge from the hospital was 1.17 +/- 0.57 mg/dL among the AKI group compared with 0.77 +/- 0.32 mg/dL among the group without AKI. Pretransplant renal impairment expressed by an elevated SCr concentration (relative risk [RR] = 1.25; P = .0386) and treatment with exogenous vasoconstrictors during the operation (RR = 2.27; P = .016) were identified as risk factors for developing AKI after liver transplantation.
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Affiliation(s)
- A Rymarz
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, 1a Banacha St, Warsaw, Poland.
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28
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Ferreira AC, Nolasco F, Carvalho D, Sampaio S, Baptista A, Pessegueiro P, Monteiro E, Mourão L, Barroso E. Impact of RIFLE classification in liver transplantation. Clin Transplant 2009; 24:394-400. [DOI: 10.1111/j.1399-0012.2009.01087.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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29
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Mukhtar A, Aboulfetouh F, Obayah G, Salah M, Emam M, Khater Y, Akram R, Hoballah A, Bahaa M, Elmeteini M, Hamza A. The safety of modern hydroxyethyl starch in living donor liver transplantation: a comparison with human albumin. Anesth Analg 2009; 109:924-30. [PMID: 19690268 DOI: 10.1213/ane.0b013e3181aed54f] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Intravascular volume replacement therapy is an important issue in the perioperative management of liver transplantation. There is paucity of data on the safety of hydroxyethyl starch (HES) in patients undergoing liver transplantation. We evaluated the safety of a new HES 130/0.4 in the perioperative management of liver transplantation, with a special emphasis on renal function. METHODS Forty patients undergoing living donor liver transplantation were prospectively randomized into two groups. Patients in the ALB group (n = 20) received 5% human albumin. Patients in the HES group (n = 20) received third generation HES (6% HES 130/0.4). Total colloid administration was limited to 50 mL x kg(-1) x d(-1). The volume was given to maintain pulmonary artery occlusion pressure or central venous pressure between 5 and 7 mm Hg. If additional fluids were required, balanced crystalloid solution was used. Anesthetic and surgical techniques were standardized. Serum creatinine and cystatin C plasma levels were measured from arterial blood samples after induction of anesthesia, at the end of surgery, and on the first 4 postoperative days. RESULTS All 40 enrolled patients completed the study. Demographic and intraoperative variables were comparable in both groups. Postoperatively, the mean +/- sd volume was 6229 +/- 1140 mL and 4636 +/- 1153 mL in HES and ALB groups, respectively (P = 0.003). There was significantly greater [corrected] net cumulative fluid balance in the HES [corrected] group 3047 +/- 2000 [corrected] mL compared with the ALB group 1100 +/- 900 [corrected] mL, P = 0.029. Serum creatinine, creatinine clearance, and cystatin C plasma levels showed no significant differences between the two groups. One patient in each group developed acute renal failure requiring renal replacement therapy. CONCLUSION The use of HES 130/0.4 as an alternative to human albumin resulted in equivalent renal outcome after liver transplantation.
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Affiliation(s)
- Ahmed Mukhtar
- Department of Anesthesia and Intensive Care, Cairo University, Giza, Egypt.
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30
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Long FW, Liang SY, Liu ZJ, Chen Y, Tu ZD, Shi YJ, Bao J, Gong J. Augmentor of liver regeneration ameliorates renal tubular epithelial cell injury after rat liver transplantation. Transplant Proc 2008; 40:2696-2699. [PMID: 18929838 DOI: 10.1016/j.transproceed.2008.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Acute renal insufficiency and dysfunction are common complications after clinical liver transplantation. This study examined whether augmentor of liver regeneration (ALR) played a significant role to ameliorate renal tubular epithelial cell injury after liver transplantation. METHODS Orthotopic liver transplantation was performed from Sprague-Dawley (SD) to SD rats. Twelve recipients were randomly divided into two groups: ALR group (with recombinated human ALR 100 microg/kg . d intramuscular injection postoperation) versus normal saline-treated group (with the same volume of normal saline injected intramuscularly postoperation). Rats were sacrificed at day 3 posttransplantation. Renal morphological changes in recipients were assessed with light microscopy. The expressions of tumor necrosis factor-alpha (TNF-alpha), proliferating cell nuclear antigen (PCNA) and caspase-3 protein and mRNA in the kidney were evaluated by real-time polymerase chain reaction and immunohistochemical staining. RESULTS Morphological changes in renal tubular epithelial cells were not significant in either group at day 3 posttransplantation. The intragraft expression of TNF-alpha and caspase-3 was strikingly promoted in the normal saline-treated group and PCNA attenuated compared to the ALR group. CONCLUSION These data suggested that ALR may play a role to reduce renal damage in liver transplant recipients.
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Affiliation(s)
- F W Long
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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31
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Afonso RC, Hidalgo R, Zurstrassen MPVC, Fonseca LEP, Pandullo FL, Rezende MB, Meira-Filho SP, Ferraz-Neto BH. Impact of renal failure on liver transplantation survival. Transplant Proc 2008; 40:808-10. [PMID: 18455024 DOI: 10.1016/j.transproceed.2008.02.062] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Renal failure after orthotopic liver transplantation (OLT) is a common complication (ranging from 12% to 70%) associated with worse outcomes, particularly when it requires renal replacement therapy (RRT). Renal dysfunction is a common scenario among waiting list patients. It can lead to a worse prognosis after OLT, due to an increased incidence of postoperative renal failure. The aim of this study was to analyze the incidence of renal failure after OLT, its relationship to pretransplant renal dysfunction, and its impact on outcomes. We analyzed data collected prospectively from 152 consecutive OLTs in 139 patients performed by the same team from March 2003 to November 2007. Exclusion criteria for 34 cases included transplantation due to acute liver failure, combined liver-kidney transplantation, retransplantation, and patients who died up to 2 days posttransplantation. Based on creatinine clearance (CCr) calculated at the time of OLT, the 118 patients were classified in two groups: group I, normal pre-OLT renal function (CCr > or = 70 mL/min) versus group II, pre-OLT renal failure (CCr < 70 mL/min). Each group was analyzed according to the development of post-OLT renal failure, being classified as subgroup A (normal renal function post-OLT), subgroup B (mild renal impairment post-OLT-serum creatinine level between 2.0 and 3.0 mg/dL or doubled basal value up to 3.0 mg/dL) versus subgroup C (severe renal impairment post-OLT-serum creatinine level > or = 3.0 mg/dL or utilization of RRT). The overall incidence of post-OLT renal impairment was 41.52% with RRT in 22 patients (18.64%). Group II patients showed a greater incidence of post-OLT renal failure when compared with other patients (P < .05), but without a statistical difference when compared according to RRT requirement. Comparison of average hospital stay was similar between groups I and II, and also among its subgroups (A, B, and C, respectively). There was no statistical difference in early (30-day) and 1-year survival rates between groups I and II. Comparing all subgroups for early and 1-year survival, we observed that patients who developed severe renal failure post-OLT (subgroups I-C and II-C) showed worse outcomes compared with other patients (subgroups I-A, I-B, II-A, and II-B), respectively 95.29% versus 69.69% and 86.95% versus 41.66% for early and 1-year survivals (P < .001). In conclusion, our findings suggested that patients who developed severe renal failure post-OLT, independent of pretransplant renal function, showed worse outcomes.
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Affiliation(s)
- R C Afonso
- Liver Transplantation Unit, Albert Einstein Jewish Hospital, São Paulo, Brazil
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32
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Ling Q, Xu X, Li JJ, Chen J, Shen JW, Zheng SS. Alternative definition of acute kidney injury following liver transplantation: based on serum creatinine and cystatin C levels. Transplant Proc 2007; 39:3257-3260. [PMID: 18089366 DOI: 10.1016/j.transproceed.2007.03.107] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2006] [Accepted: 03/05/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to verify the estimation and the predictive abilities of serum creatinine (Cr), serum cystatin C (Cys C), and related formulas for acute kidney injury (AKI). PATIENTS AND METHODS Thirty patients who underwent cadaveric donor liver transplantation were enrolled in this prospective study. Glomerular filtration rate (GFR) was assessed by the 99mTc DTPA clearance method and estimated by Cr-predicted clearances (Cockcroft-Gault method [CG] and abbreviated Modification of Diet in Renal Disease equation [MDRD]) as well as by 3 other Cys C-based formulas (Hoek, Filler, and Larsson). AKI was confirmed as GFR<80 mL/min/1.73 m2 in the first posttransplantation week. RESULTS GFR was significantly correlated with reciprocal Cr, reciprocal Cys C, and the 5 formulas (P<.001 for all). The receiver operating characteristic (ROC) area of Cys C was larger than that of Cr (.937 vs .794, P<.05). ROC area of Hoek, or Filler or Larsson was also larger than that of CG or MDRD (.937, .935, .937 vs .802, .849, P<.05 for all). ROC analysis showed the cutoff values were 1.0 mg/dL for Cr and 1.57 mg/L for Cys C. Hoek, Filler, and Larsson equations all underestimated AKI; their optimal cutoff values should be adjusted to 47, 56, and 44 mL/min/1.73 m2, respectively. CONCLUSION Cys C is a better predictor of AKI than Cr. A value of more than 1.57 mg/L might be considered a new definition of AKI.
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Affiliation(s)
- Q Ling
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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33
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Ruiz R, Barri YM, Jennings LW, Chinnakotla S, Goldstein RM, Levy MF, McKenna GJ, Randall HB, Sanchez EQ, Klintmalm GB. Hepatorenal syndrome: a proposal for kidney after liver transplantation (KALT). Liver Transpl 2007; 13:838-43. [PMID: 17539003 DOI: 10.1002/lt.21149] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Hepatorenal syndrome (HRS) is a well-recognized complication of end-stage liver disease. Once thought to be a reversible condition with liver transplantation (LT) alone, HRS may directly contribute to the requirement for long-term dialysis posttransplant. As a result, discussion has now focused on whether or when a kidney allograft should be considered for these patients. Using the International Ascites Club guidelines with a pretransplant serum creatinine (SCr) >2.0 mg/dL to define HRS, 130 patients undergoing LT over a 10-yr period were identified, for an overall incidence of 9%. Patient survival rates at 1, 3, and 5 yr were 74%, and 68%, and 62%, respectively. Survival was significantly worse when compared to non-HRS patients undergoing LT over the same study period (P = 0.0001). For patients presenting with type 2 HRS, 7 patients (6%) developed irreversible kidney failure posttransplant compared to 0.34% in the non-HRS population (P < 0.0001). Five of these patients died within 1 yr with a median survival time of 139 days. Combined liver and kidney transplantation (CLKT) for patients with HRS is not recommended. However, an improvement in outcome can be accomplished by addressing those patients who require dialysis greater than 60 days posttransplant. We propose a role for kidney after liver transplantation (KALT) in select HRS patients.
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Affiliation(s)
- Richard Ruiz
- Baylor Regional Transplant Institute, Dallas, TX 75246, USA.
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34
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O'Riordan A, Wong V, McQuillan R, McCormick PA, Hegarty JE, Watson AJ. Acute renal disease, as defined by the RIFLE criteria, post-liver transplantation. Am J Transplant 2007; 7:168-76. [PMID: 17109735 DOI: 10.1111/j.1600-6143.2006.01602.x] [Citation(s) in RCA: 132] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Acute renal failure (ARF) can complicate up to 60% of orthotopic liver transplants (OLT). The RIFLE criteria were developed to provide a consensus definition for acute renal disease in critically ill patients. Using the RIFLE criteria, we aimed to determine the incidence and risk factors for ARF and acute renal injury (ARI), and to evaluate the link with the outcomes, patient survival and length of hospital stay. Three hundred patients, who received 359 OLTs, were retrospectively analyzed. ARI and ARF occurred post 11.1 and 25.7% of OLTs, respectively. By multivariate analysis, ARI was associated with pre-OLT hypertension and alcoholic liver disease and ARF with higher pre-OLT creatinine, inotrope and aminoglycoside use. ARF, but not ARI, had an impact on 30-day and 1-year patient survival and longer length of hospital stay. ARI and ARF, as defined by the RIFLE criteria, are common complications of OLT, with distinct risk factors and ARF has serious clinical consequences. The development of a consensus definition is a welcome advance, however these criteria do need to be validated in large studies in a wide variety of patient populations.
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Affiliation(s)
- A O'Riordan
- Department of Nephrology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
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35
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Junge G, Schewior LV, Kohler S, Neuhaus R, Langrehr JM, Tullius S, Kahl A, Frei U, Neuhaus P. Acute renal failure after liver transplantation: incidence, etiology, therapy, and outcome. Transplant Proc 2006; 38:723-4. [PMID: 16647455 DOI: 10.1016/j.transproceed.2006.01.074] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Acute renal failure (ARF) was a frequent complication after orthotopic liver transplantation (OLT) when ARF was defined by a calculated glomerular filtration rate decrease of >50% or by a doubled serum creatinine above 2.5 mg/dL within the first week after OLT. We analyzed 1352 liver transplant recipients in retrospective fashion with regard to the incidence, etiology, therapy, and outcome of ARF; 162 patients developed ARF within the first week after OLT (12%), among whom 157 patients (97%) were recompensated by postoperative day 28. Altogether 52 patients (32%) received an average of 6 hemodialysis treatments, excluding the 5 patients (3%) who developed end-stage renal failure. Risk factors for this complication included hepatorenal syndrome type II, a glomerular filtration rate of <50 mL/min, and a diagnosis of hepatitis C.
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Affiliation(s)
- G Junge
- Klinik f. Allgemein-, Viszeral- und Transplantationschirurgie, Charité Universitätsmedizin Berlin, Berlin, Germany
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