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Lichtenegger P, Graf A, Schiefer J, Bilir A, Kollmann D, Berlakovich GA, Faybik P, Baron DM, Baron-Stefaniak J. The association of perioperative serum albumin concentrations with outcome after deceased donor liver transplantation. BMC Anesthesiol 2025; 25:178. [PMID: 40217182 PMCID: PMC11987330 DOI: 10.1186/s12871-025-03016-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Accepted: 03/20/2025] [Indexed: 04/15/2025] Open
Abstract
BACKGROUND Perioperative hypoalbuminemia has been associated with worse outcome after major surgery. Although hypoalbuminemia is common in patients with chronic liver disease and frequently occurs following liver transplantation (LT), data are sparse regarding perioperative hypoalbuminemia and outcome after LT. METHODS In this single-center retrospective study performed at the Medical University of Vienna, we evaluated adult patients undergoing orthotopic liver transplantation (OLT) between 2004 and 2019. The association between perioperative serum albumin concentrations and survival, acute kidney injury (AKI), and postoperative surgical complications was analyzed using cox and logistic regression models. RESULTS In total, 724 patients were analyzed. Serum albumin concentrations decreased from 32.0 ± 6.8 to 22.8 ± 4.8 g/l (nadir within 48 h following OLT). Overall survival was not associated with serum albumin concentrations on day 1, day 2, or at nadir within 48 h after OLT (Day1: HR:0.988, 95%CI:0.966-1.011, P = 0.306; Day2: HR:1.021, 95%CI:0.991-1.052, P = 0.167; Nadir: HR:0.998, 95%CI:0.971-1.025, P = 0.863). Serum albumin concentrations on day 1, day 2, or at nadir within 48 h after OLT were not associated with AKI (Day1: OR:0.975, 95%CI:0.949-1.002, P = 0.070; Day2: OR:1.011, 95%CI:0.971-1.053, P = 0.601; Nadir: HR:0.976, 95%CI:0.940-1.013, P = 0.20) or with postoperative complications (Day1: OR:0.997, 95%CI:0.976-1.059, P = 0.80; Day2: OR:1.002, 95%CI:0.973-1.032, P = 0.890; Nadir: HR:0.993, 95%CI:0.966-1.021, P = 0.610). However, we observed an increased risk for initiation of renal replacement therapy with lower serum albumin concentrations on the day preceding initiation (HR = 0.946; 95%CI:0.896-1.000; P = 0.049). CONCLUSION Hypoalbuminemia was not associated with reduced survival, the development of AKI, or postoperative surgical complications after OLT. However, postoperative hypoalbuminemia was associated with the timing of initiating renal replacement therapy after OLT.
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Affiliation(s)
- Paul Lichtenegger
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria.
| | - Alexandra Graf
- Institute of Medical Statistics, Centre for Medical Data Science, Medical University of Vienna, Vienna, Austria
| | - Judith Schiefer
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Aylin Bilir
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Dagmar Kollmann
- Department of Surgery, Medical University of Vienna, Division of Transplantation, Vienna, Austria
| | - Gabriela A Berlakovich
- Department of Surgery, Medical University of Vienna, Division of Transplantation, Vienna, Austria
| | - Peter Faybik
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - David M Baron
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Joanna Baron-Stefaniak
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
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Sun Y, Xiao Z, Zhao H, An Y. Urinary dickkopf-3 as a predictor for postoperative acute kidney injury in the intensive care unit. Am J Med Sci 2025; 369:434-442. [PMID: 39561890 DOI: 10.1016/j.amjms.2024.11.003] [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: 01/07/2024] [Revised: 11/14/2024] [Accepted: 11/15/2024] [Indexed: 11/21/2024]
Abstract
BACKGROUND As a life-threatening complication in patients undergoing surgery, acute kidney injury (AKI) is strongly associated with a worse prognosis. Urinary dickkopf-related protein 3 (DKK3) has been identified as a biomarker for predicting postoperative AKI in patients undergoing cardiac surgery. OBJECTIVE To investigate the predictive value of urinary DKK3 on postoperative AKI and develop a clinical model based on the predictor for predicting the development of AKI within seven days for patients undergoing noncardiac surgery. METHODS All patients who were admitted to the Intensive Care Unit (ICU) after noncardiac surgery from March 2023 to June 2023 were included in this study. The patients' baseline data on demographic characteristics, lifestyle risk factors, medical history, clinical features, and laboratory tests before surgery were collected at the time of admission. Besides, the blood samples for cystatin C and routine laboratory tests and the urine samples for DKK3 tests were simultaneously collected at the time of admission to the ICU. In addition, the independent predictors of postoperative AKI were identified by univariate, multivariate, and LASSO analyses. Moreover, a nomogram for predicting postoperative AKI was developed based on these independent predictors. Finally, the nomogram was evaluated through calibration and decision curve analyses. RESULTS A total of 166 patients with a median age of 67 years old were included in this study, including 94 (56.63 %) males. Among these patients, 47 patients (28.3 %) developed postoperative AKI. Additionally, 7 independent risk factors, including preoperative serum creatinine, preoperative eGFR, preoperative serum albumin, preoperative serum potassium ion, cystatin C, uDKK3/uCr, and SOFA score, were selected by univariate and multivariate regression analyses. Eventually, 4 independent risk factors (including preoperative eGFR, cystatin C, uDKK3/uCr, and SOFA score) identified in this study by LASSO analyses were used to establish the nomogram. The area under the receiver operating characteristic (ROC) curve (AUC) for the prediction model was 0.868. The calibration curve and decision curve analysis results demonstrated that the nomogram had good prediction performance. CONCLUSIONS Urinary DKK3/creatinine was independently associated with postoperative AKI for patients in the ICU after noncardiac surgery. The nomogram constructed based on uDKK3/uCr, preoperative eGFR, cystatin C, and SOFA score showed a higher accuracy in predicting postoperative AKI.
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Affiliation(s)
- Yao Sun
- Department of Critical Care Medicine, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing 100044, PR China
| | - Zengli Xiao
- Department of Critical Care Medicine, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing 100044, PR China
| | - Huiying Zhao
- Department of Critical Care Medicine, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing 100044, PR China.
| | - Youzhong An
- Department of Critical Care Medicine, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing 100044, PR China.
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3
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Pagano D, Toniutto P, Burra P, Gruttadauria S, Vella R, Martini S, Morelli MC, Svegliati-Baroni G, Marrone G, Ponziani FR, Caraceni P, Angeli P, Calvaruso V, Giannelli V. Perioperative administration of albumin in adult patients undergoing liver transplantation: A systematic review. Dig Liver Dis 2025; 57:819-826. [PMID: 39645428 DOI: 10.1016/j.dld.2024.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 11/08/2024] [Accepted: 11/14/2024] [Indexed: 12/09/2024]
Abstract
Hypoalbuminemia is a risk factor for mortality in patients with end-stage liver disease (ESLD) and in those undergoing orthotopic liver transplantation (OLT), since it represents a biomarker of post-operative delayed functional recovery of the graft. Despite albumin infusion during and after OLT is frequently adopted in recipients with hypoalbuminemia, it remains unclear whether this procedure could improve post OLT clinical outcomes. Observational studies indicated that treatment with albumin after OLT might be beneficial in reducing ascites and acute kidney injury (AKI) development. However, considering potential complications and the cost of albumin therapy, the decision to use albumin after OLT should be based on careful consideration of patient's individual needs and risks. In addition, the threshold plasma value of albumin below which it could be clinically useful to infuse albumin has not been clearly defined. This systematic review, prepared in accordance with the PRISMA 2020 guidelines, aimed to assess the efficacy of albumin infusion in patients undergoing OLT, in the prevention or treatment of ascites, AKI, and ischemia reperfusion syndrome, as well as its potential impact on patient survival. Furthermore, this review aimed to illustrate the pathophysiological bases justifying the use of albumin infusion in a subset of patients receiving OLT.
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Affiliation(s)
- Duilio Pagano
- Department for the Treatment and the Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Mediterraneoper i Trapianti e Terapie ad alta specializzazione), UPMCI (University of Pittsburgh Medical Center Italy), Palermo, Italy
| | - Pierluigi Toniutto
- Hepatology and Liver Transplantation Unit, Azienda Ospedaliero Universitaria, University of Udine 33100, Udine, Italy.
| | - Patrizia Burra
- Gastroenterology and Multivisceral Transplant Unit, Azienda Ospedale-Università Padova, Department of Surgery, Oncology and Gastroenterology, University of Padova 35122, Padova, Italy
| | - Salvatore Gruttadauria
- Department for the Treatment and the Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Mediterraneoper i Trapianti e Terapie ad alta specializzazione), UPMCI (University of Pittsburgh Medical Center Italy) Palermo, Italy; University of Catania, Catania, Italy
| | - Roberta Vella
- Department for the Treatment and the Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Mediterraneoper i Trapianti e Terapie ad alta specializzazione), UPMCI (University of Pittsburgh Medical Center Italy) Palermo, Italy; Department of Precision Medicine in the Medical, Surgical and Critical Care Area University of Palermo, Palermo, Italy
| | - Silvia Martini
- Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Maria Cristina Morelli
- RCCS Azienda Ospedaliero-Universitaria di Bologna, Internal Medicine Unit for the treatment of Severe Organ Failure, Bologna, Italy
| | | | - Giuseppe Marrone
- Liver Transplant Medicine Unit, Fondazione Policlinico Universitario Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesca Romana Ponziani
- Hepatology Unit, CEMAD Centro Malattie dell'Apparato Digerente, Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
| | - Paolo Caraceni
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy; Unit of Semeiotics, IRCCS AOU Bologna, Bologna, Italy
| | - Paolo Angeli
- Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Padova, Italy
| | - Vincenza Calvaruso
- Gastroenterology and Hepatology Unit, Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, University of Palermo 90127 Palermo, Italy
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Redinger JW, Johnson KM, Slawski BA. Perioperative Liver and Kidney Diseases. Med Clin North Am 2024; 108:1119-1134. [PMID: 39341617 DOI: 10.1016/j.mcna.2024.04.001] [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] [Indexed: 10/01/2024]
Abstract
Perioperative risks associated with acute hepatitis, cirrhosis, and chronic kidney disease are substantial and prevalence of underlying chronic kidney or liver disease is rising; surgeries in these populations have accordingly become more common. Optimal perioperative management in both cases is paramount; this article focuses on understanding disease pathophysiology, a targeted preoperative evaluation, accurate estimation of perioperative risk, and anticipation and management of common postoperative complications.
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Affiliation(s)
- Jeffrey W Redinger
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, USA; Hospital and Specialty Medicine, VA Puget Sound Healthcare System, 1660 South Columbian Way (S-111-MED), Seattle, WA 98108, USA.
| | - Kay M Johnson
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, USA; Hospital and Specialty Medicine, VA Puget Sound Healthcare System, 1660 South Columbian Way (S-111-MED), Seattle, WA 98108, USA
| | - Barbara A Slawski
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, The Hub for Collaborative Medicine, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
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Batsuuri B, Avirmed S, Batbold C, Lopez-Verdugo F, Nunez J, Togtokh A, Orgoi S. Risk factors for renal impairment after liver transplantation in Mongolia: a retrospective single-center study. CLINICAL TRANSPLANTATION AND RESEARCH 2024; 38:128-135. [PMID: 38940688 PMCID: PMC11228376 DOI: 10.4285/ctr.24.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/16/2024] [Accepted: 05/24/2024] [Indexed: 06/29/2024]
Abstract
Background Renal impairment (RI) is a frequent complication of liver cirrhosis and is associated with increased mortality and morbidity. Liver transplantation (LT) serves as an effective treatment method for patients with cirrhosis who have impaired renal function. However, renal function often declines after LT, influenced by various factors. This study aimed to investigate the factors contributing to RI following LT in our cases. Methods We analyzed the demographic data, preoperative and perioperative parameters, and postoperative outcomes of patients who underwent LT at the First Central Hospital of Mongolia from September 2011 to December 2022. Renal function was assessed by measuring the glomerular filtration rate using the Cockcroft-Gault creatinine clearance formula pretransplantation and at 24 hours, 72 hours, 7 days, 14 days, and 28 days post-LT. Results Several factors increased the risk of RI among recipients. These included female sex (odds ratio [OR], 3.06; 95% confidence interval [CI], 1.58-5.91), Child-Turcotte-Pugh (CTP) scores of B and C (OR, 4.23; 95% CI, 0.92-19.41 and OR, 7.68; 95% CI, 1.67-35.30, respectively), preoperative continuous renal replacement therapy (CRRT; OR, 5.86; 95% CI, 1.1-31.21), and a high graft-to-recipient weight ratio (GRWR; OR, 3.45; 95% CI, 1.23-9.63). Additionally, the survival rates for recipients with RI post-LT were 93.4% at 1 year and 78.1% at 3 years. Conclusions Female sex, a high CTP score, preoperative CRRT, and high GRWR were identified as risk factors for RI after LT in Mongolia.
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Affiliation(s)
- Batsaikhan Batsuuri
- Graduate School, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
- Department of Surgery, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
- The Transplantation Center, The First Central Hospital of Mongolia, Ulaanbaatar, Mongolia
| | - Shiirevnyamba Avirmed
- Graduate School, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
- Department of Surgery, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Chuluunbileg Batbold
- Department of Internal Medicine, Health Development Center, Ulaanbaatar, Mongolia
| | | | - Jade Nunez
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Ariunaa Togtokh
- Department of Nephrology, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Sergelen Orgoi
- Department of Surgery, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
- The Transplantation Center, The First Central Hospital of Mongolia, Ulaanbaatar, Mongolia
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Jabiry-Zieniewicz Z, Stelmach DA, Jasak K, Knap-Wielgus W, Szumska A, Kalicinski P, Sanko-Resmer J, Szpotanska-Sikorska M. Pregnancy in Liver and Kidney Female Recipient: A Case Report. Transplant Proc 2024; 56:998-999. [PMID: 38729837 DOI: 10.1016/j.transproceed.2024.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 03/29/2024] [Indexed: 05/12/2024]
Abstract
Deterioration of kidney function after orthotopic liver transplantation is a common complication that may occur after perioperative acute kidney injury (AKI) and preexisting or developing chronic kidney disease (CKD). AKI is described in the early postoperative period in more than half of recipients, whereas the main cause of CKD is pharmacotherapy. When end-stage renal failure occurs, patients may be qualified for additional transplantations. We present a rare case of a 27-year-old woman who, as a teenager, underwent 2 liver transplantations due to Wilson's disease. Surgeries were complicated by systemic infection and multiple organ failure. The kidneys did not regain their function, and therefore, after 6 months of dialysis, the organ was transplanted. Three organ transplantations were performed. Due to the patient's willingness and good graft functions, the patient started trying to conceive. Three months before successful conception, immunosuppressive therapy was changed to tacrolimus and azathioprine. Pregnancy was complicated by pregnancy-induced hypertension, and its course was closely monitored. Organ functions and immunosuppressive therapy were regularly assessed. Due to the pre-eclampsia developed in the 35th week of gestation, a Cesarean delivery was performed, and she gave birth to a daughter weighing 2350 g (Apgar 7-7-8). The patient decided to breastfeed. There were no obstetric complications or graft function deterioration in the early postpartum period. Mother and daughter left home after 7 days of hospitalization. The presented clinical situation proves that multiorgan transplantation recipients can have a successful pregnancy without impairing graft functions. Therefore, the pregnancy requires adequate preparation and increased care.
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Affiliation(s)
| | - Daria Ada Stelmach
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Kamil Jasak
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Weronika Knap-Wielgus
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Agnieszka Szumska
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Kalicinski
- Department of Paediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Warsaw, Poland
| | - Joanna Sanko-Resmer
- Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
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Chen G, Hu X, Huang Y, Xiang X, Pan S, Chen R, Xu X. Role of the immune system in liver transplantation and its implications for therapeutic interventions. MedComm (Beijing) 2023; 4:e444. [PMID: 38098611 PMCID: PMC10719430 DOI: 10.1002/mco2.444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 11/23/2023] [Accepted: 11/24/2023] [Indexed: 12/17/2023] Open
Abstract
Liver transplantation (LT) stands as the gold standard for treating end-stage liver disease and hepatocellular carcinoma, yet postoperative complications continue to impact survival rates. The liver's unique immune system, governed by a microenvironment of diverse immune cells, is disrupted during processes like ischemia-reperfusion injury posttransplantation, leading to immune imbalance, inflammation, and subsequent complications. In the posttransplantation period, immune cells within the liver collaboratively foster a tolerant environment, crucial for immune tolerance and liver regeneration. While clinical trials exploring cell therapy for LT complications exist, a comprehensive summary is lacking. This review provides an insight into the intricacies of the liver's immune microenvironment, with a specific focus on macrophages and T cells as primary immune players. Delving into the immunological dynamics at different stages of LT, we explore the disruptions after LT and subsequent immune responses. Focusing on immune cell targeting for treating liver transplant complications, we provide a comprehensive summary of ongoing clinical trials in this domain, especially cell therapies. Furthermore, we offer innovative treatment strategies that leverage the opportunities and prospects identified in the therapeutic landscape. This review seeks to advance our understanding of LT immunology and steer the development of precise therapies for postoperative complications.
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Affiliation(s)
- Guanrong Chen
- The Fourth School of Clinical MedicineZhejiang Chinese Medical UniversityHangzhouChina
| | - Xin Hu
- Zhejiang University School of MedicineHangzhouChina
- Key Laboratory of Integrated Oncology and Intelligent Medicine of Zhejiang ProvinceHangzhouChina
| | - Yingchen Huang
- The Fourth School of Clinical MedicineZhejiang Chinese Medical UniversityHangzhouChina
| | - Xiaonan Xiang
- Zhejiang University School of MedicineHangzhouChina
- Key Laboratory of Integrated Oncology and Intelligent Medicine of Zhejiang ProvinceHangzhouChina
| | - Sheng Pan
- Zhejiang University School of MedicineHangzhouChina
- Key Laboratory of Integrated Oncology and Intelligent Medicine of Zhejiang ProvinceHangzhouChina
| | - Ronggao Chen
- Department of Hepatobiliary and Pancreatic SurgeryThe First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Xiao Xu
- Zhejiang University School of MedicineHangzhouChina
- Key Laboratory of Integrated Oncology and Intelligent Medicine of Zhejiang ProvinceHangzhouChina
- Zhejiang Chinese Medical UniversityHangzhouChina
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Huwyler F, Eden J, Binz J, Cunningham L, Sousa Da Silva RX, Clavien P, Dutkowski P, Tibbitt MW, Hefti M. A Spectrofluorometric Method for Real-Time Graft Assessment and Patient Monitoring. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2301537. [PMID: 37265001 PMCID: PMC10427358 DOI: 10.1002/advs.202301537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/03/2023] [Indexed: 06/03/2023]
Abstract
Biomarkers are powerful clinical diagnostics and predictors of patient outcome. However, robust measurements often require time and expensive laboratory equipment, which is insufficient to track rapid changes and limits direct use in the operating room. Here, this study presents a portable spectrophotometric device for continuous real-time measurements of fluorescent and non-fluorescent biomarkers at the point of care. This study measures the mitochondrial damage biomarker flavin mononucleotide (FMN) in 26 extended criteria human liver grafts undergoing hypothermic oxygenated perfusion to guide clinical graft assessment. Real-time data identified seven organs unsuitable for transplant that are discarded. The remaining grafts are transplanted and FMN values correlated with post-transplant indicators of liver function and patient recovery. Further, this study shows how this device can be used to monitor dialysis patients by measuring creatinine in real-time. Our approach provides a simple method to monitor biomarkers directly within biological fluids to improve organ assessment, patient care, and biomarker discovery.
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Affiliation(s)
- Florian Huwyler
- Macromolecular Engineering Lab, Department of Mechanical and Process EngineeringETH ZurichZurich8092Switzerland
- Department of Surgery and Transplantation, Swiss Hepato‐Pancreato‐Biliary (HPB) and Transplant CenterUniversity Hospital ZurichZurich8091Switzerland
- Wyss Zurich Translational CenterETH Zurich and University of ZurichZurich8092Switzerland
| | - Janina Eden
- Department of Surgery and Transplantation, Swiss Hepato‐Pancreato‐Biliary (HPB) and Transplant CenterUniversity Hospital ZurichZurich8091Switzerland
| | - Jonas Binz
- Macromolecular Engineering Lab, Department of Mechanical and Process EngineeringETH ZurichZurich8092Switzerland
| | - Leslie Cunningham
- Macromolecular Engineering Lab, Department of Mechanical and Process EngineeringETH ZurichZurich8092Switzerland
- Department of Surgery and Transplantation, Swiss Hepato‐Pancreato‐Biliary (HPB) and Transplant CenterUniversity Hospital ZurichZurich8091Switzerland
- Wyss Zurich Translational CenterETH Zurich and University of ZurichZurich8092Switzerland
| | - Richard X. Sousa Da Silva
- Department of Surgery and Transplantation, Swiss Hepato‐Pancreato‐Biliary (HPB) and Transplant CenterUniversity Hospital ZurichZurich8091Switzerland
- Wyss Zurich Translational CenterETH Zurich and University of ZurichZurich8092Switzerland
| | - Pierre‐Alain Clavien
- Department of Surgery and Transplantation, Swiss Hepato‐Pancreato‐Biliary (HPB) and Transplant CenterUniversity Hospital ZurichZurich8091Switzerland
- Wyss Zurich Translational CenterETH Zurich and University of ZurichZurich8092Switzerland
| | - Philipp Dutkowski
- Department of Surgery and Transplantation, Swiss Hepato‐Pancreato‐Biliary (HPB) and Transplant CenterUniversity Hospital ZurichZurich8091Switzerland
| | - Mark W. Tibbitt
- Macromolecular Engineering Lab, Department of Mechanical and Process EngineeringETH ZurichZurich8092Switzerland
- Wyss Zurich Translational CenterETH Zurich and University of ZurichZurich8092Switzerland
| | - Max Hefti
- Wyss Zurich Translational CenterETH Zurich and University of ZurichZurich8092Switzerland
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9
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Kim D, Kim J, Han S, Jung H, Park HD, Ko JS, Gwak MS, Kim GS. Effects of 20% albumin infusion therapy during liver transplantation on plasma neutrophil gelatinase-associated lipocalin level: A randomized controlled trial. Liver Transpl 2023; 29:861-870. [PMID: 36749856 DOI: 10.1097/lvt.0000000000000089] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 12/30/2022] [Indexed: 02/09/2023]
Abstract
The risk of acute kidney injury (AKI) after liver transplantation was lower in patients with serum albumin levels ≥3.0 mg/dL during surgery. We tested whether intraoperative infusion of 20% albumin affects neutrophil gelatinase-associated lipocalin (NGAL) level, a reliable indicator of AKI. We randomly assigned 134 patients undergoing liver transplantation into albumin group (n=70, 20% albumin 200 mL) and the control group (n=66, crystalloid solution 200 mL). The 2 study fluids were infused at 100 mL/h from the start of the anhepatic phase. The primary outcome was plasma NGAL level at 1 hour after graft reperfusion. Albumin level at the start of graft reperfusion was significantly greater in albumin group than in the control group [2.9 (2.4-3.3) g/dL vs. 2.3 (2.0-2.7) g/dL, p <0.001]. The NGAL level at 1 hour after graft reperfusion was not significantly different between the 2 groups [100.2 (66.7-138.8) ng/mL vs. 92.9 (70.8-120.6) ng/mL, p =0.46], and the AKI risk was not either (63.9% vs. 67.8%, adjusted p =0.73). There were no significant differences between the 2 groups regarding hospital readmission within 30 days/90 days after transplantation (32.6% vs. 41.5%, adjusted p =0.19 and 55.0% vs. 55.7%, adjusted p =0.87). Graft survival probability at 30 days/90 days/1 year after transplantation was 90.0%/84.3%/78.6% in albumin group and 97.0%/90.9%/89.4% in the control group [HR=1.6 (0.6-4.0), adjusted p =0.31]. In conclusion, intraoperative infusion of 20% albumin 200 mL increased the albumin level but failed to maintain serum albumin ≥3.0 mg/dL during surgery. The hypertonic albumin therapy did not significantly affect plasma NGAL level and clinical outcomes including AKI.
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Affiliation(s)
- Doyeon Kim
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, Pochun CHA University School of Medicine, Seongnam, Republic of Korea
| | - Jeayoun Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sangbin Han
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyunjoo Jung
- Department of Anesthesiology and Pain Medicine, Gangnam Severance Hospital, Yonsei University School of Medicine, Seoul, Republic of Korea
| | - Hyung-Doo Park
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Justin S Ko
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Mi Sook Gwak
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gaab Soo Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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10
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Doganci M, Zeyneloğlu P, Kayhan Z, Ayhan A. Determination of Risk Factors for Postoperative Acute Kidney Injury in Patients With Gynecologic Malignancies. Cureus 2023; 15:e41836. [PMID: 37575800 PMCID: PMC10423056 DOI: 10.7759/cureus.41836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 08/15/2023] Open
Abstract
Background Postoperative acute kidney injury (AKI) is an important cause of mortality and morbidity among surgical patients. There is little information on the occurrence of AKI after operations for gynecologic malignancies. This study aimed to determine the incidence of AKI in patients who underwent surgery for gynecological malignancies and determine the risk factors in those who developed postoperative AKI. Methodology A total of 1,000 patients were enrolled retrospectively from January 2007 to March 2013. AKI was defined according to the Kidney Disease Improving Global Outcomes 2012 Clinical Practice Guideline for Acute Kidney Injury. Perioperative variables of patients were collected from medical charts. Results The incidence of postoperative AKI was 8.8%, with stage 1 occurring in 5.9%, stage 2 in 2.4%, and stage 3 in 0.5% of the patients. Patients who had AKI were significantly older, had higher body mass index (BMI) higher preoperative C-reactive protein (CRP) levels, and more frequently had a history of distant organ metastasis when compared with those who did not have AKI. When compared with patients who did not develop AKI postoperatively, longer operation times and intraoperative usage of higher amounts of erythrocyte suspension and fresh frozen plasma were seen in those who developed AKI. Conclusions Patients who had AKI were older, had higher BMI with higher preoperative CRP levels, more frequent distant organ metastasis, longer operation times, and higher amounts of blood transfused intraoperatively. Defining preoperative, intraoperative, and postoperative risk factors for postoperative AKI and taking necessary precautions are important for the early detection and intervention of AKI.
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Affiliation(s)
- Melek Doganci
- Department of Critical Care, Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, TUR
| | - Pınar Zeyneloğlu
- Department of Anesthesiology and Intensive Care Unit, Başkent University Faculty of Medicine, Ankara, TUR
| | - Zeynep Kayhan
- Department of Anesthesiology and Reanimation, Başkent University Faculty of Medicine, Ankara, TUR
| | - Ali Ayhan
- Department of Obstetrics and Gynecology, Başkent University Faculty of Medicine, Ankara, TUR
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11
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Association between intraoperative oliguria and postoperative acute kidney injury in non-cardiac surgical patients: a systematic review and meta-analysis. J Anesth 2022; 37:219-233. [PMID: 36520229 DOI: 10.1007/s00540-022-03150-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE This systematic review and meta-analysis aimed to evaluate the association between intraoperative oliguria and the risk of postoperative acute kidney injury (AKI) in patients undergoing non-cardiac surgery. METHODS The MEDLINE and EMBASE databases were searched up to August 2022 for studies in adult patients undergoing non-cardiac surgery, where the association between intraoperative urine output and the risk of postoperative AKI was assessed. Both randomised and non-randomised studies were eligible for inclusion. Study selection and risk of bias assessment were independently performed by two investigators. The risk of bias was evaluated using the Newcastle-Ottawa scale. We performed meta-analysis of the reported multivariate adjusted odds ratios for the association between intraoperative oliguria (defined as urine output < 0.5 mL/kg/hr) and the risk of postoperative AKI using the inverse-variance method with random effects models. We conducted sensitivity analyses using varying definitions of oliguria as well as by pooling unadjusted odds ratios to establish the robustness of the primary meta-analysis. We also conducted subgroup analyses according to surgery type and definition of AKI to explore potential sources of clinical or methodological heterogeneity. RESULTS Eleven studies (total 49,252 patients from 11 observational studies including a post hoc analysis of a randomised controlled trial) met the selection criteria. Seven of these studies contributed data from a total 17,148 patients to the primary meta-analysis. Intraoperative oliguria was associated with a significantly elevated risk of postoperative AKI (pooled adjusted odds ratio [OR] 1.74; 95% confidence interval [CI] 1.36-2.23, p < 0.0001, 8 studies). Sensitivity analyses supported the robustness of the primary meta-analysis. There was no evidence of any significant subgroup differences according to surgery type or definition of AKI. CONCLUSIONS This study demonstrated a significant association between intraoperative oliguria and the risk of postoperative AKI, regardless of the definitions of oliguria or AKI used. Further prospective and multi-centre studies using standardised definitions of intraoperative oliguria are required to define the thresholds of oliguria and establish strategies to minimise the risk of AKI.
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12
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Sáez de la Fuente I, Sáez de la Fuente J, Martín Badia I, Chacón Alves S, Molina Collado Z, Sánchez-Bayton Griffith M, Lesmes González de Aledo A, González Fernandez M, Gutiérrez Gutiérrez J, Sánchez Izquierdo Riera JÁ. Postoperative Blood Pressure Deficit and Acute Kidney Injury After Liver Transplant. EXP CLIN TRANSPLANT 2022; 20:992-999. [PMID: 36524885 DOI: 10.6002/ect.2022.0272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Acute kidney injury is a common cause of morbidity in liver transplant recipients. In critically ill patients who received an orthotopic liver transplant, we examined whether those with acute kidney injury had a greater deficit between pretransplant and posttransplant hemodynamic pressure-related parameters compared with those without acute kidney injury in the early postoperative period. MATERIALS AND METHODS We included patients who underwent an orthotopic liver transplant during the study period. We obtained premorbid and intensive care unit time-weighted average values for hemodynamic pressure-related parameters (systolic, diastolic, and mean arterial pressure; central venous pressure; mean perfusion pressure; and diastolic perfusion pressure) and calculated deficits in those values. We defined acute kidney injury progression as an increase of ≥1 Kidney Disease: Improving Global Outcomes stage. RESULTS We included 150 eligible transplantrecipients, with 88 (59%) having acute kidney injury progression. Acute kidney injury was associated with worse clinical outcomes. All achieved pressure-related values were similar between transplant recipients with or without acute kidney injury progression. However, those with acute kidney injury versus those without progression had greater diastolic perfusion pressure deficit at 12 hours (-8.33% vs 1.93%; P = .037) and 24 hours (-7.38% vs 5.11%; P = .002) and increased central venous pressure at 24 hours (46.13% vs 15%; P = .043) and 48 hours (40% vs 20.87%; P = .039). CONCLUSIONS Patients with acute kidney injury progression had a greater diastolic perfusion pressure deficit and increased central venous pressure compared with patients without progression. Such deficits might be modifiable risk factors for the prevention of acute kidney injury progression.
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13
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Lv C, Zhou B, Zhang D, Lin J, Sun L, Zhang Z, Ding Y, Sun R, Zhang J, Zhou C, Zhang L, Wang X, Ke L, Li W, Li B. The effects of bicarbonated versus acetated Ringer's solutions on acid-base status and kidney injury following orthotopic liver transplantation: Protocol for a single-centre, randomised controlled trial (The BETTER trial). Front Surg 2022; 9:1019570. [PMID: 36338625 PMCID: PMC9630575 DOI: 10.3389/fsurg.2022.1019570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/03/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The ideal crystalloid fluid of choice for fluid therapy during liver transplantation is unknown. Conventional balanced crystalloids are buffered with organic anions, which requires liver metabolism to prevent matabolic acidosis and protect renal function. Therefore they can not function properly during liver transplantation. On the contrary, the bicarbonated Ringer's solution (BRS) can maintain acid-base status regardless of liver function. In this study, we aimed to test the hypothesis that, in patients undergoing orthotopic liver transplantation, compared with acetated Ringer's solutions (ARS), perioperative fluid therapy with BRS could better maintain the acid-base status. METHODS This is a prospective, single-centre, randomised controlled trial. 72 eligible patients will be randomised to receive either BRS or ARS perioperatively. The primary endpoint is the difference in standard base excess (SBE) before and after operation. Secondary endpoints include the incidence of acute kidney injury (AKI) within 48 h post operation and free and alive days to day 14 for intensive care admission, invasive ventilation, vasopressors, and renal replacement therapy (RRT). DISCUSSION Metabolic acidosis is common perioperatively, potentially leading to decreased renal blood flow and reduced glomerular filtration rate. The use of balanced solutions can prevent hyperchloremic metabolic acidosis, thereby avoiding AKI in some patients. However, during liver transplantation, when well-functioning liver metabolism is lacking, the organic anions in conventional balanced solutions may remain strong anions and thus fail to maintain the acid-base status, but no solid clinical evidence exists now. This study will, for the first time, provide evidence on the relative effects of BRS vs. ARS on acid-base status and renal injury in patients undergoing liver transplantation. CLINICAL TRIAL REGISTRATION The trial has been registered at the Chinese Clinical Trials Registry (ChiCTR2100046889) on 29 May 2021.
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Affiliation(s)
- Cheng Lv
- Department of Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Bin Zhou
- Department of Anaesthesiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Donghua Zhang
- Department of Oncology Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Jiajia Lin
- Department of Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Lingling Sun
- Department of Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Zhenzhen Zhang
- Department of Anaesthesiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Yuan Ding
- Department of Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Rong Sun
- Department of Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Jie Zhang
- Department of Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Chuyao Zhou
- Department of Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Li Zhang
- Department of Laboratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Xuan Wang
- Department of Oncology Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Lu Ke
- Department of Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China,Correspondence: Baiqiang Li Weiqin Li Lu Ke
| | - Weiqin Li
- Department of Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China,Correspondence: Baiqiang Li Weiqin Li Lu Ke
| | - Baiqiang Li
- Department of Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China,Correspondence: Baiqiang Li Weiqin Li Lu Ke
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14
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Abstract
Postoperative AKI is a common complication of major surgery and is associated with significant morbidity and mortality. The Kidney Disease Improving Global Outcomes AKI definition allows consensus classification and identification of postoperative AKI through changes in serum creatinine and/or urine output. However, such conventional diagnostic criteria may be inaccurate in the postoperative period, suggesting a potential to refine diagnosis by application of novel diagnostic biomarkers. Risk factors for the development of postoperative AKI can be thought of in terms of preoperative, intraoperative, and postoperative factors and, as such, represent areas that may be targeted perioperatively to minimize the risk of AKI. The treatment of postoperative AKI remains predominantly supportive, although application of management bundles may translate into improved outcomes.
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Affiliation(s)
- Naomi Boyer
- Department of Critical Care, Royal Surrey Hospital, Guildford, United Kingdom
- SPACeR Group (Surrey Peri-Operative, Anaesthesia and Critical Care Collaborative Research Group), Royal Surrey Hospital, Guildford, United Kingdom
| | - Jack Eldridge
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
- Adult Critical Care Unit, Royal London Hospital Barts Health National Health Service Trust, London, United Kingdom
| | - John R. Prowle
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
- Adult Critical Care Unit, Royal London Hospital Barts Health National Health Service Trust, London, United Kingdom
| | - Lui G. Forni
- Department of Critical Care, Royal Surrey Hospital, Guildford, United Kingdom
- SPACeR Group (Surrey Peri-Operative, Anaesthesia and Critical Care Collaborative Research Group), Royal Surrey Hospital, Guildford, United Kingdom
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, University of Surrey, Guildford, United Kingdom
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15
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Martín LG, Vázquez-Garza JN, Grande AM, González MCM, Martín CF, Polo IDLH, Roux DP, Rojo MG, García FL. Postreperfusion Syndrome in Liver Transplant: A Risk Factor for Acute Kidney Failure: A Retrospective Analysis. Transplant Proc 2022; 54:2277-2284. [PMID: 36192211 DOI: 10.1016/j.transproceed.2022.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/29/2022] [Accepted: 08/26/2022] [Indexed: 10/07/2022]
Abstract
The maximum expression of hemodynamic instability during liver transplant is the so-called postreperfusion syndrome (PRS) that increases both overall mortality and postoperative complications. It was first defined by Aggarwal et al in 1987, but the results are still conflicting when establishing the relationship between PRS and acute kidney failure (AKF). We conducted a retrospective observational study of transplant recipients with deceased-donor liver grafts between January 2002 and December 2018. We analyzed the incidence of PRS and its potential negative impact over kidney function. A total of 551 transplants were analyzed. PRS was recorded in 130 patients (23.6%). The incidence of AKF was 61.5%. A total of 111 patients required kidney replacement therapy (32.7%). Regarding the severity of AKF, 128 patients were classified as acute kidney injury (AKI) 1 (23.2%), 76 as AKI 2 (13.8%), and 135 as AKI 3 (24.5%). In the group with PRS, 75.4% (n = 98) developed AKF vs 57.2% (n = 241) in the group without PRS. In the multivariate analysis we found a relationship between PRS and AKF with an odds ratio of 2.18 (95% CI, 1.30-3.64; P = .003), once adjusted by the length of the anhepatic phase, donor age, Model for End-Stage Liver Disease score, history of ascites, and need for early surgical reintervention. The incidence of AKF decreased (44.5%) ever since the implementation of delayed calcineurin inhibitors therapy and piggyback surgical technique, but a clear influence of the occurrence of PRS on the development of AKF is still observed, with an OR of 3.78 (95% CI, 1.92-7.43; P < .001), once adjusted by albumin and hemoglobin levels, Model for End-Stage Liver Disease score, and Child classification.
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Affiliation(s)
- L Gajate Martín
- Department of Anesthesiology and Critical Care, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | | | - A Martín Grande
- Department of Anesthesiology and Critical Care, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - M C Martín González
- Department of Anesthesiology and Critical Care, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - C Fernández Martín
- Department of Anesthesiology and Critical Care, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - I De la Hoz Polo
- Department of Anesthesiology and Critical Care, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - D Parise Roux
- Department of Anesthesiology and Critical Care, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - M Gómez Rojo
- Department of Anesthesiology and Critical Care, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - F Liaño García
- Department of Anesthesiology and Critical Care, Hospital Universitario Ramón y Cajal, Madrid, Spain; Department of Nephrology, Hospital Universitario Ramón y Cajal, Madrid, Spain
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16
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Swanson KJ. Kidney disease in non-kidney solid organ transplantation. World J Transplant 2022; 12:231-249. [PMID: 36159075 PMCID: PMC9453292 DOI: 10.5500/wjt.v12.i8.231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 04/07/2022] [Accepted: 07/11/2022] [Indexed: 02/05/2023] Open
Abstract
Kidney disease after non-kidney solid organ transplantation (NKSOT) is a common post-transplant complication associated with deleterious outcomes. Kidney disease, both acute kidney injury and chronic kidney disease (CKD) alike, emanates from multifactorial, summative pre-, peri- and post-transplant events. Several factors leading to kidney disease are shared amongst solid organ transplantation in addition to distinct mechanisms unique to individual transplant types. The aim of this review is to summarize the current literature describing kidney disease in NKSOT. We conducted a narrative review of pertinent studies on the subject, limiting our search to full text studies in the English language. Kidney disease after NKSOT is prevalent, particularly in intestinal and lung transplantation. Management strategies in the peri-operative and post-transplant periods including proteinuria management, calcineurin-inhibitor minimization/ sparing approaches, and nephrology referral can counteract CKD progression and/or aid in subsequent kidney after solid organ transplantation. Kidney disease after NKSOT is an important consideration in organ allocation practices, ethics of transplantation. Kidney disease after SOT is an incipient condition demanding further inquiry. While some truths have been revealed about this chronic disease, as we have aimed to describe in this review, continued multidisciplinary efforts are needed more than ever to combat this threat to patient and allograft survival.
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Affiliation(s)
- Kurtis J Swanson
- Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, MN 55414, United States
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17
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Berkowitz RJ, Engoren MC, Mentz G, Sharma P, Kumar SS, Davis R, Kheterpal S, Sonnenday CJ, Douville NJ. Intraoperative risk factors of acute kidney injury following liver transplantation. Liver Transpl 2022; 28:1399-1400. [PMID: 35434880 DOI: 10.1002/lt.26477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/24/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Rachel J Berkowitz
- Surgical Analytics and Population Health, Data Analytics and Reporting, Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Milo C Engoren
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Graciela Mentz
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Pratima Sharma
- Division of Gastroenterology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Sathish S Kumar
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Ryan Davis
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Sachin Kheterpal
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Christopher J Sonnenday
- Section of Transplantation, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan, USA.,Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.,Institute of Healthcare Policy & Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicholas J Douville
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, Michigan, USA.,Institute of Healthcare Policy & Innovation, University of Michigan, Ann Arbor, Michigan, USA
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18
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Berkowitz RJ, Engoren MC, Mentz G, Sharma P, Kumar SS, Davis R, Kheterpal S, Sonnenday CJ, Douville NJ. Intraoperative risk factors of acute kidney injury after liver transplantation. Liver Transpl 2022; 28:1207-1223. [PMID: 35100664 PMCID: PMC9321139 DOI: 10.1002/lt.26417] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/06/2022] [Accepted: 01/10/2022] [Indexed: 01/13/2023]
Abstract
Acute kidney injury (AKI) is one of the most common complications of liver transplantation (LT). We examined the impact of intraoperative management on risk for AKI following LT. In this retrospective observational study, we linked data from the electronic health record with standardized transplant outcomes. Our primary outcome was stage 2 or 3 AKI as defined by Kidney Disease Improving Global Outcomes guidelines within the first 7 days of LT. We used logistic regression models to test the hypothesis that the addition of intraoperative variables, including inotropic/vasopressor administration, transfusion requirements, and hemodynamic markers improves our ability to predict AKI following LT. We also examined the impact of postoperative AKI on mortality. Of the 598 adult primary LT recipients included in our study, 43% (n = 255) were diagnosed with AKI within the first 7 postoperative days. Several preoperative and intraoperative variables including (1) electrolyte/acid-base balance disorder (International Classification of Diseases, Ninth Revision codes 253.6 or 276.x and International Classification of Diseases, Tenth Revision codes E22.2 or E87.x, where x is any digit; adjusted odds ratio [aOR], 1.917, 95% confidence interval [CI], 1.280-2.869; p = 0.002); (2) preoperative anemia (aOR, 2.612; 95% CI, 1.405-4.854; p = 0.002); (3) low serum albumin (aOR, 0.576; 95% CI, 0.410-0.808; p = 0.001), increased potassium value during reperfusion (aOR, 1.513; 95% CI, 1.103-2.077; p = 0.01), and lactate during reperfusion (aOR, 1.081; 95% CI, 1.003-1.166; p = 0.04) were associated with posttransplant AKI. New dialysis requirement within the first 7 days postoperatively predicted the posttransplant mortality. Our study identified significant association between several potentially modifiable variables with posttransplant AKI. The addition of intraoperative data did not improve overall model discrimination.
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Affiliation(s)
- Rachel J. Berkowitz
- Surgical Analytics and Population HealthData Analytics and ReportingLurie Children’s Hospital of ChicagoChicagoIllinoisUSA
| | - Milo C. Engoren
- Department of AnesthesiologyMichigan MedicineAnn ArborMichiganUSA
| | - Graciela Mentz
- Department of AnesthesiologyMichigan MedicineAnn ArborMichiganUSA
| | - Pratima Sharma
- Division of GastroenterologyDepartment of Internal MedicineMichigan MedicineAnn ArborMichiganUSA
| | - Sathish S. Kumar
- Department of AnesthesiologyMichigan MedicineAnn ArborMichiganUSA
| | - Ryan Davis
- Department of AnesthesiologyMichigan MedicineAnn ArborMichiganUSA
| | - Sachin Kheterpal
- Department of AnesthesiologyMichigan MedicineAnn ArborMichiganUSA
| | - Christopher J. Sonnenday
- Division of Transplantation SurgeryDepartment of SurgeryMichigan MedicineAnn ArborMichiganUSA,School of Public HealthUniversity of MichiganAnn ArborMichiganUSA
| | - Nicholas J. Douville
- Department of AnesthesiologyMichigan MedicineAnn ArborMichiganUSA,Institute of Healthcare Policy & InnovationUniversity of MichiganAnn ArborMichiganUSA
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19
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Neves APCDF, Gomes AGDR, Vassallo PF, Silva ACSE, Penna FGCE, Bastos FDL, Muniz MR, Rocha GC, dos Santos ACS, Ravetti CG, Nobre V. Risk factors for acute kidney injury after liver transplantation in intensive care unit: a retrospective cohort study. SAO PAULO MED J 2022; 140:559-565. [PMID: 35946679 PMCID: PMC9491471 DOI: 10.1590/1516-3180.2021.0641.r2.12112021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/12/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a frequent complication during the postoperative period following liver transplantation. Occurrence of AKI in intensive care unit (ICU) patients is associated with increased mortality and higher costs. OBJECTIVE To evaluate occurrences of moderate or severe AKI among patients admitted to the ICU after liver transplantation and investigate characteristics associated with this complication. DESIGN AND SETTING Single-center retrospective cohort study in a public hospital, Belo Horizonte, Brazil. METHODS Forty-nine patients admitted to the ICU between January 2015 and April 2017 were included. AKI was defined from a modified Kidney Disease Improving Global Outcomes (KDIGO) score (i.e. based exclusively on serum creatinine levels). RESULTS Eighteen patients (36.7%) developed AKI KDIGO 2 or 3; mostly KDIGO 3 (16 out of the 18 patients). Lactate level within the first six hours after ICU admission (odds ratio, OR: 1.3; 95% confidence interval, CI: 1.021-1.717; P = 0.034) and blood transfusion requirement within the first week following transplantation (OR: 8.4; 95% CI: 1.687-41.824; P = 0.009) were independently associated with development of AKI. Patients with AKI KDIGO 2 or 3 underwent more renal replacement therapy (72.2% versus 3.2%; P < 0.01), had longer hospital stay (20 days versus 15 days; P = 0.001), higher in-hospital mortality (44.4% versus 6.5%; P < 0.01) and higher mortality rate after one year (44.4% versus 9.7%; P = 0.01). CONCLUSION Need for blood transfusion during ICU stay and hyperlactatemia within the first six postoperative hours after liver transplantation are independently associated with moderate or severe AKI. Developing AKI is apparently associated with poor outcomes.
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Affiliation(s)
- Ana Paula Camargos de Figueirêdo Neves
- MD. Physician and Master’s Student, Postgraduate Program on Infectology and Tropical Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Angélica Gomides dos Reis Gomes
- MD. Physician and Master’s Student, Postgraduate Program on Infectology and Tropical Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Paula Frizera Vassallo
- MD, PhD. Physician in the Intensive Care Unit, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Ana Cristina Simões e Silva
- MD, PhD. Physician, Department of Pediatrics, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | | | - Fabrício de Lima Bastos
- MD. Physician, Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Mateus Rocha Muniz
- Undergraduate Medical Student, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Guilherme Carvalho Rocha
- Undergraduate Medical Student, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Augusto Cesar Soares dos Santos
- MD, PhD. Physician, Department of Nephrology, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Cecilia Gómez Ravetti
- MD, PhD. Physician, Department of Internal Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Vandack Nobre
- MD, PhD. Physician, Postgraduate Program on Infectology and Tropical Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
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20
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Januszko-Giergielewicz B, Kobryń A, Donderski R, Trzcinska J, Theda-Pawelska J, Romaszko-Wojtowicz A, Shevchuk A, Słupski M. Hepatorenal Syndrome and Other Post-Liver Transplantation Complications: Case Studies and Literature Review. Transplant Proc 2022; 54:1029-1036. [PMID: 35760626 DOI: 10.1016/j.transproceed.2022.03.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/05/2022] [Accepted: 03/14/2022] [Indexed: 01/09/2023]
Abstract
Hepatorenal syndrome (HRS) was originally defined as a renal dysfunction caused by a decreased renal perfusion due to hemodynamic disturbances in the arterial circulation and an excessive activity of endogenous vasoactive systems in the course of cirrhosis. Considering the latest research, this syndrome may have a more complex pathomechanism. Equally often as in cirrhosis, HRS develops after orthotopic liver transplantation (OLTx) and worsens the prognosis significantly increasing mortality rates in this patient population. The prevalence of renal complications after OLTx and their negative prognostic impact on the survival of both the graft and the recipient prompted the authors of this work to analyze in detail 2 cases of HRS after OLTx to indicate the multiplicity of factors contributing to the pathophysiology of this syndrome. Attention was paid to risk factors for HRS found in the anamnesis before OLTx, especially a pre-existing renal dysfunction. In both cases early post-OLTx complications associated with the transplantation procedure were described: destabilization of the circulatory system, transfusions of blood products, prolonged stay at an intensive care unit, and necessity of introducing continuous renal replacement therapy. In the later period after the OLTx, infections (bacterial, fungal, viral) and drug nephrotoxicity, including the activity of immunosuppressants (tacrolimus), contributed primarily to the renal function impairment.
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Affiliation(s)
- Beata Januszko-Giergielewicz
- Clinic of General, Liver and Transplant Surgery, University Hospital No 1 in Bydgoszcz named after Dr A. Jurasz, Collegium Medicum, Nicolaus Copernicus University in Toruń, Poland.
| | - Andrzej Kobryń
- Clinic of General, Liver and Transplant Surgery, University Hospital No 1 in Bydgoszcz named after Dr A. Jurasz, Collegium Medicum, Nicolaus Copernicus University in Toruń, Poland
| | - Rafał Donderski
- Department of Nephrology, Internal Diseases and Hypertention, University Hospital No 1 in Bydgoszcz named after Dr A. Jurasz, Collegium Medicum, Nicolaus Copernicus University in Toruń, Poland
| | - Joanna Trzcinska
- Clinic of General, Liver and Transplant Surgery, University Hospital No 1 in Bydgoszcz named after Dr A. Jurasz, Collegium Medicum, Nicolaus Copernicus University in Toruń, Poland
| | - Joanna Theda-Pawelska
- Clinic of General, Liver and Transplant Surgery, University Hospital No 1 in Bydgoszcz named after Dr A. Jurasz, Collegium Medicum, Nicolaus Copernicus University in Toruń, Poland
| | - Anna Romaszko-Wojtowicz
- Department of Pulmonology, Faculty of Public Health, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Poland
| | - Andii Shevchuk
- Clinic of General, Liver and Transplant Surgery, University Hospital No 1 in Bydgoszcz named after Dr A. Jurasz, Collegium Medicum, Nicolaus Copernicus University in Toruń, Poland
| | - Maciej Słupski
- Clinic of General, Liver and Transplant Surgery, University Hospital No 1 in Bydgoszcz named after Dr A. Jurasz, Collegium Medicum, Nicolaus Copernicus University in Toruń, Poland
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21
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Heda R, Kovalic AJ, Satapathy SK. Peritransplant Renal Dysfunction in Liver Transplant Candidates. Clin Liver Dis 2022; 26:255-268. [PMID: 35487609 DOI: 10.1016/j.cld.2022.01.010] [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] [Indexed: 01/31/2023]
Abstract
Renal function is intricately tied to Model for End-Stage Liver Disease score and overall prognosis among patients with cirrhosis. The estimation of glomerular filtration rate (GFR) and etiology of renal impairment are even more magnified among cirrhotic patients in the period surrounding liver transplantation. Novel biomarkers including cystatin C and urinary neutrophil gelatinase-associated lipocalin have been demonstrated to more accurately assess renal dysfunction and aid in the diagnosis of competing etiologies. Accurately identifying the severity and chronicity of renal dysfunction among transplant candidates is an imperative component with respect to stratifying patients toward simultaneous liver-kidney transplantation versus liver transplantation alone.
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Affiliation(s)
- Rajiv Heda
- Department of Internal Medicine, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Alexander J Kovalic
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Manhasset, NY 11030, USA
| | - Sanjaya K Satapathy
- Department of Medicine, Division of Hepatology, Sandra Atlas Bass Center for Liver Diseases and Transplantation, Manhasset, NY 11030, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, 400 Community Drive, Manhasset, NY 11030, USA.
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22
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Norén Å, Åberg F, Mölne J, Bennet W, Friman S, Herlenius G. Perioperative kidney injury in liver transplantation: a prospective study with renal histology and measured glomerular filtration rates. Scand J Gastroenterol 2022; 57:595-602. [PMID: 35060823 DOI: 10.1080/00365521.2022.2028004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) is frequent after liver transplantation (LT), with impact on graft function, morbidity and mortality. Although multifactorial, the pathophysiology of perioperative kidney injury remains unclear. Our aims were to analyze the frequency, evolution and risk factors for kidney impairment during the peri- and early post-operative period. METHODS In a prospective, single-center study of 27 adult patients undergoing first single-organ LT, we analyzed measured glomerular filtration rate (mGFR) pre-transplant, at post-operative day (POD) 10, and at 1, 3, 12 and 36 months. Kidney and liver graft biopsies were performed during LT. RESULTS A median mGFR decline of 45% was detected from pre-transplant to POD 10, correlating strongly with the mGFR evolution from baseline to 12 months (rs = 0.80, p<.001) and baseline to 36 months (rs = 0.82, p<.001). AKI occurred in 59% of recipients within 48 h of LT, notably before the introduction of calcineurin inhibitors on POD 3. AKI was strongly associated with mGFR at 12 and 36 months. Kidney and liver graft biopsies showed only minor histological changes. Donor and recipient body mass index, recipient age, model of end-stage liver disease score, diagnosis of hepatitis C, donor cause of death, as well as bleeding, transfusions and duration of the anhepatic phase correlated with early kidney dysfunction. CONCLUSION The greatest decline in mGFR was evident within 10 days and AKI within hours of LT, irrespective of baseline mGFR and before introduction of calcineurin inhibitors. Very early post-LT kidney injury has substantial consequences for long-term kidney function.
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Affiliation(s)
- Åsa Norén
- The Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Surgery, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Fredrik Åberg
- The Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan Mölne
- Laboratory Medicine, Institute of Biomedicine, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - William Bennet
- The Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Surgery, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Styrbjörn Friman
- The Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Surgery, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gustaf Herlenius
- The Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Surgery, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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23
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Massicotte L, Hevesi Z, Zaouter C, Thibeault L, Karakiewicz P, Roy L, Roy A. Association of Phlebotomy on Blood Product Transfusion Requirements During Liver Transplantation: An Observational Cohort Study on 1000 Cases. Transplant Direct 2022; 8:e1258. [PMID: 35372673 PMCID: PMC8963830 DOI: 10.1097/txd.0000000000001258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 12/22/2022] Open
Abstract
Background During the past 2 decades, transfusion requirements have decreased drastically during orthotopic liver transplantation (OLT), and transfusion-free transplantation is nowadays increasingly common. Understanding that liberal intravenous volume loading in cirrhotic patients may have detrimental consequences is key. In contrast, phlebotomy is a method to lower central venous pressure and portal venous pressure. The objective of this study was to determine the effectiveness and safety of phlebotomy in the early phase of blood transfusion, blood loss, renal function, and mortality. Methods The present study evaluated the impact of phlebotomy on bleeding, transfusion rate, renal dysfunction, and mortality in 1000 consecutive OLTs. Two groups were defined and compared using phlebotomy. Multivariate logistic and linear regression models were used to determine predictors of bleeding, red blood cell (RBC) transfusion, renal dysfunction, and mortality. Results A mean of 0.7 ± 1.5 RBC units was transfused per patient for 1000 OLTs, 75% did not receive any RBCs, and the median and interquartile range (25-75) were 0 for all blood products transfused. The phlebotomy was associated with decreased transfusion (RBCs, plasma, platelets, cryoprecipitate, albumin), with less bleeding, and with an increased survival rate, both 1 mo and 1 y. Phlebotomy was not associated with renal dysfunction. Conclusions The practice of phlebotomy to lower portal venous pressure was associated with reduced blood product transfusions and blood loss during liver dissection without deleterious effect on renal function.
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Affiliation(s)
- Luc Massicotte
- Anesthesiology Department, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Zoltan Hevesi
- Anaesthesiology Department, University of Wisconsin, Madison, WI
| | - Cédrick Zaouter
- Anesthesiology Department, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Lynda Thibeault
- Epidemiology Department, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Pierre Karakiewicz
- Urology Division, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Louise Roy
- Internal Medicine Department, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - André Roy
- Hepatobiliary Division, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
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24
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Fiorelli S, Biancofiore G, Feltracco P, Lavezzo B, DE Gasperi A, Pompei L, Masiero L, Testa S, Ricci A, Della Rocca G. Acute kidney injury after liver transplantation, perioperative risk factors, and outcome: prospective observational study of 1681 patients (OLTx Study). Minerva Anestesiol 2022; 88:248-258. [PMID: 34709014 DOI: 10.23736/s0375-9393.21.15860-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) represents a frequent complication after orthotopic liver transplantation (OLT). This study aimed to evaluate early postoperative AKI incidence during the first 72 h after OLT, perioperative risk factors, and AKI impact on survival. METHODS From January 2011 to December 2013, 1681 patients underwent OLT in 19 centers and were enrolled in this prospective cohort study. RESULTS According to RIFLE criteria, AKI occurred in 367 patients, 21.8% (R: 5.8%, I: 6.4%, F: 4.8%, L: 4.8%). Based on multivariate analysis, intraoperative risk factors for AKI were: administration of 5-10 RBCs (OR 1.8, 95% CI 1.3-2.7), dopamine use (OR 1.6, 95% CI 1.2-2.3), post-reperfusion syndrome (OR 1.5, 95% CI 1.0-2.3), surgical complications (OR 2.0, 95% CI 1.3-3.0), and cardiological complications (OR 2.2, 95% CI 1.2-4.0). Postoperative risk factors were: norepinephrine (OR 1.4, 95% CI 1.0-2.0), furosemide (OR 4.2, 95% CI 3.0-5.9), more than 10 RBCs transfusion, (OR 3.7, 95% CI 1.4-10.5), platelets administration (OR 1.6, 95% CI 1.1-2.4), fibrinogen administration (OR 3.0, 95% CI, 1.5-6.2), hepatic complications (OR 4.6, 95% CI 2.9-7.5), neurological complications (OR 2.4, 95% CI 1.5-3.7), and infectious complications (OR 2.7, 95% CI 1.8-4.3). NO-AKI patients' 5-year survival rate was higher than AKI patients (68.06, 95% CI 62.7-72.7 and 81.2, 95% CI 78.9-83.3, P<0.001). CONCLUSIONS AKI still remains an important risk factor for morbidity and mortality after OLT. Further research to develop new strategies aimed at preventing or minimizing post-OLT AKI is needed.
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Affiliation(s)
- Silvia Fiorelli
- Department of Anesthesiology and Intensive Care, Sapienza University, Rome, Italy -
| | | | | | - Bruna Lavezzo
- Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | | | - Livia Pompei
- Department of Medical Area, University of Udine, Udine, Italy
| | - Lucia Masiero
- National Transplant Center, Italian National Institute of Health (ISS), Rome, Italy
| | - Silvia Testa
- National Transplant Center, Italian National Institute of Health (ISS), Rome, Italy
| | - Andrea Ricci
- National Transplant Center, Italian National Institute of Health (ISS), Rome, Italy
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25
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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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26
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Yang M, Peng B, Zhuang Q, Li J, Liu H, Cheng K, Ming Y. Models to predict the short-term survival of acute-on-chronic liver failure patients following liver transplantation. BMC Gastroenterol 2022; 22:80. [PMID: 35196992 PMCID: PMC8867783 DOI: 10.1186/s12876-022-02164-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/15/2022] [Indexed: 12/23/2022] Open
Abstract
Background Acute-on-chronic liver failure (ACLF) is featured with rapid deterioration of chronic liver disease and poor short-term prognosis. Liver transplantation (LT) is recognized as the curative option for ACLF. However, there is no standard in the prediction of the short-term survival among ACLF patients following LT. Method Preoperative data of 132 ACLF patients receiving LT at our center were investigated retrospectively. Cox regression was performed to determine the risk factors for short-term survival among ACLF patients following LT. Five conventional score systems (the MELD score, ABIC, CLIF-C OFs, CLIF-SOFAs and CLIF-C ACLFs) in forecasting short-term survival were estimated through the receiver operating characteristic (ROC). Four machine-learning (ML) models, including support vector machine (SVM), logistic regression (LR), multi-layer perceptron (MLP) and random forest (RF), were also established for short-term survival prediction. Results Cox regression analysis demonstrated that creatinine (Cr) and international normalized ratio (INR) were the two independent predictors for short-term survival among ACLF patients following LT. The ROC curves showed that the area under the curve (AUC) ML models was much larger than that of conventional models in predicting short-term survival. Among conventional models the model for end stage liver disease (MELD) score had the highest AUC (0.704), while among ML models the RF model yielded the largest AUC (0.940). Conclusion Compared with the traditional methods, the ML models showed good performance in the prediction of short-term prognosis among ACLF patients following LT and the RF model perform the best. It is promising to optimize organ allocation and promote transplant survival based on the prediction of ML models. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02164-6.
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Affiliation(s)
- Min Yang
- Transplantation Center, Third Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
| | - Bo Peng
- Transplantation Center, Third Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
| | - Quan Zhuang
- Transplantation Center, Third Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
| | - Junhui Li
- Transplantation Center, Third Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
| | - Hong Liu
- Transplantation Center, Third Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
| | - Ke Cheng
- Transplantation Center, Third Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
| | - Yingzi Ming
- Transplantation Center, Third Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.
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27
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Platt E, Klootwijk E, Salama A, Davidson B, Robertson F. Literature review of the mechanisms of acute kidney injury secondary to acute liver injury. World J Nephrol 2022; 11:13-29. [PMID: 35117976 PMCID: PMC8790308 DOI: 10.5527/wjn.v11.i1.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/12/2021] [Accepted: 12/25/2021] [Indexed: 02/06/2023] Open
Abstract
People exposed to liver ischaemia reperfusion (IR) injury often develop acute kidney injury and the combination is associated with significant morbidity and mortality. Molecular mediators released by the liver in response to IR injury are the likely cause of acute kidney injury (AKI) in this setting, but the mediators have not yet been identified. Identifying the mechanism of injury will allow the identification of therapeutic targets which may modulate both liver IR injury and AKI following liver IR injury.
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Affiliation(s)
- Esther Platt
- Division of Surgery and Interventional Science, University College London, London NW3 2QG, United Kingdom
| | - Enriko Klootwijk
- Department of Renal Medicine, University College London, London NW3 2PF, United Kingdom
| | - Alan Salama
- Department of Renal Medicine, University College London, London NW3 2PF, United Kingdom
| | - Brian Davidson
- Division of Surgery and Interventional Science, University College London, London NW3 2QG, United Kingdom
| | - Francis Robertson
- Division of Surgery and Interventional Science, University College London, London NW3 2QG, United Kingdom
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28
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Park J, Kim SU, Choi HJ, Hong SH, Chae MS. Predictive Role of the D-Dimer Level in Acute Kidney Injury in Living Donor Liver Transplantation: A Retrospective Observational Cohort Study. J Clin Med 2022; 11:450. [PMID: 35054144 PMCID: PMC8779454 DOI: 10.3390/jcm11020450] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 02/01/2023] Open
Abstract
This study aimed to determine the association between serum D-dimer levels and the risk of acute kidney injury (AKI) in patients undergoing living donor liver transplantation (LDLT). Clinical data of 675 patients undergoing LDLT were retrospectively analyzed. The exclusion criteria included a history of kidney dysfunction, emergency cases, and missing data. The final study population of 617 patients was divided into the normal and high D-dimer groups (cutoff: 0.5 mg/L). After LDLT, 145 patients (23.5%) developed AKI. A high D-dimer level (>0.5 mg/L) was an independent predictor of postoperative development of AKI in the multivariate analysis when combined with diabetes mellitus [DM], platelet count, and hourly urine output. AKI was significantly higher in the high D-dimer group than in the normal D-dimer group (odds ratio [OR], 2.792; 95% confidence interval [CI], 1.227-6.353). Patients with a high D-dimer exhibited a higher incidence of early allograft dysfunction, longer intensive care unit stay, and a higher mortality rate. These results could improve the risk stratification of postoperative AKI development by encouraging the determination of preoperative D-dimer levels in patients undergoing LDLT.
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Affiliation(s)
- Jaesik Park
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (J.P.); (S.H.H.)
| | - Sung Un Kim
- Department of Anesthesiology and Pain Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Korea;
| | - Ho Joong Choi
- Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Sang Hyun Hong
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (J.P.); (S.H.H.)
| | - Min Suk Chae
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (J.P.); (S.H.H.)
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29
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Lim SY, Wang R, Tan DJH, Ng CH, Lim WH, Quek J, Syn N, Nah BKY, Wong ETY, Huang DQ, Vathsala A, Siddiqui MS, Fung J, Muthiah MD, Tan EXX. A meta-analysis of the cumulative incidence, risk factors, and clinical outcomes associated with chronic kidney disease after liver transplantation. Transpl Int 2021; 34:2524-2533. [PMID: 34714569 DOI: 10.1111/tri.14149] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/19/2021] [Accepted: 09/29/2021] [Indexed: 12/15/2022]
Abstract
Chronic kidney disease (CKD) remains a relatively common complication after liver transplantation (LT), and significantly impacts overall survival. We sought to assess the cumulative incidence, risk factors and mortality associated with post-LT CKD. CKD was defined as eGFR <60 ml/min/1.73 m2 as estimated by the Modified Diet in Renal Disease (MDRD) formula. Single-arm meta-analysis was done to evaluate the cumulative incidence of CKD at 1-, 3-, and 5-year timepoints post-LT. Risk factors for CKD were evaluated using hazard ratios (HR). Twenty-one studies involving 44 383 patients were included. Cumulative incidence of stage 3-5 CKD was 31.44% (CI 0.182-0.447), 36.71% (CI 0.188-0.546), and 43.52% (CI 0.296-0.574) at 1, 3, and 5 years after LT, respectively. Stage 5 CKD cumulative incidence increased from 0.274% (CI 0.001-0.005) at 1 year to 2.06% (CI 0.009-0.045) at 5 years post-LT. Age, female sex, diabetes, and peri-operative acute kidney injury (AKI) were significant risk factors for CKD. Stage 4-5 CKD was associated with a decrease in overall survival (HR 3.23, 95% CI 1.74-5.98, P < 0.01). CKD after LT is relatively common, and is associated with significantly reduced overall survival. Identification of patients at high risk of developing CKD allows physicians to prophylactically use renal-sparing immunosuppression which may be crucial in achieving desirable clinical outcomes.
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Affiliation(s)
- Sze Yinn Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Renaeta Wang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jingxuan Quek
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicholas Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Biostatistics & Modelling Domain, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Benjamin Kai Yi Nah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Emmett Tsz-Yeung Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University Center for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Daniel Q Huang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University Center for Organ Transplantation, National University Health System, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Anantharaman Vathsala
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University Center for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Mohammad Shadab Siddiqui
- Division of Gastroenterology and Hepatology, Virginia Commonwealth University, Richmond, VA, USA
| | - James Fung
- Division of Gastroenterology and Hepatology, Department of Medicine, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Mark D Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University Center for Organ Transplantation, National University Health System, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Eunice Xiang-Xuan Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University Center for Organ Transplantation, National University Health System, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
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30
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Hizomi Arani R, Abbasi MR, Mansournia MA, Nassiri Toosi M, Jafarian A, Moosaie F, Karimi E, Moazzeni SS, Abbasi Z, Shojamoradi MH. Acute Kidney Injury After Liver Transplant: Incidence, Risk Factors, and Impact on Patient Outcomes. EXP CLIN TRANSPLANT 2021; 19:1277-1285. [PMID: 34775941 DOI: 10.6002/ect.2021.0300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Acute kidney injury is a frequent complication of liver transplant. Here, we assessed the rate and contributing factors of acute kidney injury and need for renal replacement therapy in patients undergoing liver transplant at a transplant center in Tehran, Iran. MATERIAL AND METHODS We identified all patients who underwent liver transplant at the Imam Khomeini Hospital Complex from March 2018 to March 2019 and who were followed for 3 months after transplant. Acute kidney injury was defined based on the Acute Kidney Injury Network criteria. We collected demographic and pretransplant, intraoperative, and posttransplant data. Univariable and multivariable models were applied to explore independent risk factors for acute kidney injury incidence and need for renal replacement therapy. RESULTS Our study included 173 deceased donor liver transplant recipients. Rates of incidence of acute kidney injury and need for renal replacement therapy were 68.2% and 14.5%, respectively. The 3-month mortality rate among those with severe and mild or moderate acute kidney injury was 44.0% (14/25) and 9.7% (9/ 93), respectively (P < .001). Multivariable analyses indicated that serum albumin (relative risk of 0.55; 95% confidence interval, 0.34-0.87; P = .021), baseline serum creatinine (relative risk of 2.11; 95% confidence interval, 1.56-2.90; P = .037), and intraoperative mean arterial pressure (relative risk of 0.76; 95% confidence interval, 0.63-0.82; P = .008) were independent factors for predicting posttransplant acute kidney injury. Independent risk factors for requiring renal replacement therapy were pretransplant serum creatinine (relative risk of 1.99; 95% confidence interval, 1.89-4.47; P = .044) and intraoperative vasopressor infusion (relative risk of 1.41; 95% confidence interval, 1.38-2.00; P = .021). CONCLUSIONS We found a high incidence of acute kidney injury among liver transplant recipients in our center. There was a significant association between severity of acute kidney injury and 3-month and in-hospital mortality.
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Affiliation(s)
- Reyhane Hizomi Arani
- From the Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran.,the Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Dong V, Nadim MK, Karvellas CJ. Post-Liver Transplant Acute Kidney Injury. Liver Transpl 2021; 27:1653-1664. [PMID: 33963666 DOI: 10.1002/lt.26094] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/19/2021] [Accepted: 04/26/2021] [Indexed: 12/13/2022]
Abstract
Acute kidney injury (AKI) is a common condition following liver transplantation (LT). It negatively impacts patient outcomes by increasing the chances of developing chronic kidney disease and reducing graft and patient survival rates. Multiple definitions of AKI have been proposed and used throughout the years, with the International Club of Ascites definition being the most widely now used for patients with cirrhosis. Multiple factors are associated with the development of post-LT AKI and can be categorized into pre-LT comorbidities, donor and recipient characteristics, operative factors, and post-LT factors. Many of these factors can be optimized in an attempt to minimize the risk of AKI occurring and to improve renal function if AKI is already present. A special consideration during the post-LT phase is needed for immunosuppression as certain immunosuppressive medications can be nephrotoxic. The calcineurin inhibitor tacrolimus (TAC) is the mainstay of immunosuppression but can result in AKI. Several strategies including use of the monoclonoal antibody basilixamab to allow for delayed initiation of tacrolimus therapy and minimization through combination and minimization or elimination of TAC through combination with mycophenolate mofetil or mammalian target of rapamycin inhibitors have been implemented to reverse and avoid AKI in the post-LT setting. Renal replacement therapy may ultimately be required to support patients until recovery of AKI after LT. Overall, by improving renal function in post-LT patients with AKI, outcomes can be improved.
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Affiliation(s)
- Victor Dong
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Alberta, Canada.,Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta, Canada
| | - Mitra K Nadim
- Division of Nephrology and Hypertension, University of Southern California, Los Angeles, CA
| | - Constantine J Karvellas
- Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta, Canada.,Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
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Mejia C, Yadav A. Kidney Disease After Nonkidney Solid Organ Transplant. Adv Chronic Kidney Dis 2021; 28:577-586. [PMID: 35367026 DOI: 10.1053/j.ackd.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 11/11/2022]
Abstract
Nonkidney solid organ transplants (NKSOTs) are increasing in the United States with improving long-term allograft and patient survival. CKD is prevalent in patients with NKSOT and is associated with increased morbidity and mortality especially in those who progress to end-stage kidney disease. Calcineurin inhibitor nephrotoxicity is a main contributor to CKD after NKSOT, but other factors in the pretransplant, peritransplant, and post-transplant period can predispose to progressive kidney dysfunction. The management of CKD after NKSOT generally follows society guidelines for native kidney disease. Kidney-protective and calcineurin inhibitor-sparing immunosuppression has been explored in this population and warrants a discussion with transplant teams. Kidney transplantation in NKSOT recipients remains the kidney replacement therapy of choice for suitable candidates, as it provides a survival benefit over remaining on dialysis.
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Liu D, Zhang C, Hu M, Su K. Scutellarein relieves the death and inflammation of tubular epithelial cells in ischemic kidney injury by degradation of COX-2 protein. Int Immunopharmacol 2021; 101:108193. [PMID: 34619498 DOI: 10.1016/j.intimp.2021.108193] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/07/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Acute kidney injury (AKI) is a clinical syndrome that usually caused by ischemia/reperfusion (I/R). Previous studies have revealed the protection of scutellarein against ischemia in nervous system. This study aimed to demonstrate the potential of scutellarein in ischemic AKI. METHODS Animal model of ischemic AKI was established by clamping bilateral kidney pedicles in Sprague-Dawley rats. HK-2 cells were exposed to oxygen glucose deprivation/reoxygenation (OGD/R) to induce a cell model of AKI. The effects of scutellarein pre-treatment were detected by H&E staining, TUNEL, ELISA, CCK-8, LDH activity assay, ROS generation, flow cytometry, qRT-PCR and western blotting. Bioinformatic analysis was performed to probe the targets of scutellarein. RESULTS The blood urea nitrogen (BUN) and serum creatinine (SCr) levels in rats treated with scutellarein were lower than that in model groups. Scutellarein suppressed the pathological injury of kidney, and dose-dependently inhibited the apoptosis and pro-inflammatory cytokines release (IL-1β, IL-6 and IL-18). Scutellarein prevented OGD/R-induced HK-2 cell loss and cytotoxicity. ROS generation, apoptosis, and inflammation induced by OGD/R were all inhibited by scutellarein. By searching on the TCMSP and Symmap databases, COX-2 was screened out as a target of scutellarein. Scutellarein has no significant impacts on COX-2 mRNA expression, but could inhibit its protein level. Scutellarein promoted COX-2 protein degradation via enhancing autophagy. Furthermore, overexpression of COX-2 partly eliminated the renal protection of scutellarein in HK-2 cells. CONCLUSIONS Scutellarein was suggested as a renal protective agent against ischemia-induced damage in AKI. The protective properties of scutellarein may be through inhibition of COX-2.
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Affiliation(s)
- Dong Liu
- Department of Nephrology, The first affiliated hospital of Zhengzhou university, Zhengzhou, Henan, 450052, PR China.
| | - Cuijie Zhang
- Department of Nephrology, The first affiliated hospital of Zhengzhou university, Zhengzhou, Henan, 450052, PR China
| | - Min Hu
- Department of Nephrology, The first affiliated hospital of Zhengzhou university, Zhengzhou, Henan, 450052, PR China
| | - Kangle Su
- Department of Nephrology, The first affiliated hospital of Zhengzhou university, Zhengzhou, Henan, 450052, PR China
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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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Kim JM, Kim DG, Kim J, Lee K, Lee KW, Ryu JH, Kim BW, Choi DL, You YK, Kim DS, Nah YW, Kang KJ, Cho JY, Hong G, Yu HC, Moon JI, Choi D, Hwang S, Kim MS. Outcomes after liver transplantation in Korea: Incidence and risk factors from Korean transplantation registry. Clin Mol Hepatol 2021; 27:451-462. [PMID: 33525077 PMCID: PMC8273644 DOI: 10.3350/cmh.2020.0292] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/11/2021] [Accepted: 01/29/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND/AIMS To analyze the incidence and risk factors of outcomes after liver transplantation (LT) in the Korean population. METHODS This study analyzed data from the liver cohort of Korean Organ Transplantation Registry (KOTRY) who had LT between May 2014 and December 2017. Study measures included the incidence of post-LT outcomes in recipients of living donor LT (LDLT) and deceased donor LT (DDLT). Cox multivariate proportional hazards model was used to determine the potential risk factors predicting the outcomes. RESULTS A total of 2,563 adult recipients with LT (LDLT, n=1,956; DDLT, n=607) were included, with mean±standard deviation age of 53.9±8.9 years, and 72.2% were male. The post-LT outcomes observed in each LDLT and DDLT recipients were death (4.0% and 14.7%), graft loss (5.0% and 16.1%), rejection (7.0% and 12.0%), renal failure (2.7% and 13.8%), new onset of diabetes (12.5% and 15.4%), and hepatocellular carcinoma (HCC) recurrence (both 6.7%). In both LDLT and DDLT recipients, the most common post-LT complications were renal dysfunction (33.6% and 51.4%), infection (26.7% and 48.4%), and surgical complication (22.5% and 23.9%). Incidence of these outcomes were generally higher among recipients of DDLT than LDLT. Multivariate analysis indicated recipient age and DDLT as significant risk factors associated with death and graft loss. DDLT and ABO incompatible transplant were prognostic factors for rejection, and HCC beyond Milan criteria at pre-transplant was a strong predictor of HCC recurrence. CONCLUSION This study is a good indicator of the post-LT prognosis in the Korean population and suggests a significant burden of post-LT complications.
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Affiliation(s)
- Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Deok Gie Kim
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | | | | | - Kwang-Woong Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Je Ho Ryu
- Division of Hepato-Biliary-Pancreatic Surgery and liver Transplantation, Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Bong-Wan Kim
- Department of Liver Transplantation and Hepatobiliary Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Dong Lak Choi
- Department of Surgery, Catholic University of Daegu College of Medicine, Daegu, Korea
| | - Young Kyoung You
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Sik Kim
- Division of HBP Surgery & Liver Transplantation, Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Yang Won Nah
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Koo Jeong Kang
- Department of Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Jai Young Cho
- Department of Surgery, Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Geun Hong
- Department of Surgery, Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hee Chul Yu
- Department of Surgery, Jeonbuk National University Medical School, Jeonju, Korea
| | - Ju Ik Moon
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Dongho Choi
- Department of Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Shin Hwang
- Department of Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Myoung Soo Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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Park J, Joo MA, Choi HJ, Hong SH, Park CS, Choi JH, Chae MS. Predictive utility of fibrinogen in acute kidney injury in living donor liver transplantation: A propensity score-matching analysis. PLoS One 2021; 16:e0252715. [PMID: 34086798 PMCID: PMC8177619 DOI: 10.1371/journal.pone.0252715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 05/20/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND This study investigated the association between the fibrinogen level and the risk of acute kidney injury (AKI) in patients who have undergone living donor liver transplantation (LDLT). PATIENTS AND METHODS A total of 676 patients who underwent LDLT were analyzed retrospectively. Exclusion criteria included a history of severe kidney dysfunction, emergency operation, deceased donor, ABO-incompatible transplantation, and missing data. The study population was divided into low and normal fibrinogen groups. A 1:1 propensity score (PS) matching analysis was used to evaluate the association between a low fibrinogen level (< 160 mg/dL) and postoperative development of AKI. RESULTS In total, 142 patients (23.1%) developed AKI after LDLT. The PS matching analysis showed that the probability of AKI was two-fold higher in the low fibrinogen group than in the normal fibrinogen group. In addition, patients with AKI had poorer postoperative outcomes such as longer hospitalization, longer ICU stay, and higher mortality than patients without AKI. CONCLUSIONS The preoperative fibrinogen level may be useful for risk stratification of patients undergoing LDLT in terms postoperative development of AKI.
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Affiliation(s)
- Jaesik Park
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min A Joo
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ho Joong Choi
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Hyun Hong
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chul Soo Park
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong Ho Choi
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min Suk Chae
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Chen Y, Mu S, Wang J, Wu A. Chronic severe hepatitis and preoperative creatinine are independent risk factors for acute kidney injury after liver transplantation. ANNALS OF TRANSLATIONAL MEDICINE 2021; 8:1663. [PMID: 33490175 PMCID: PMC7812221 DOI: 10.21037/atm-20-7680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background Orthotopic liver transplantation (OLT) offers the highest chance of cure in comparison with all other treatment for liver tumors and other end stage liver disease. However, the complications caused by liver transplantation significantly affect its therapeutic effect, and acute kidney injury (AKI) is one of the most common of these. It is, therefore, necessary to identify the risk factors of AKI after liver transplantation. Methods A single-center, retrospective study of patients receiving liver transplantation at the Beijing Chao-Yang Hospital between January 2015 to January 2019 was conducted. Patients were divided into a normal control group and AKI group based on their previous medical history. Preoperative and intraoperative indicators including preoperative creatinine, uric acid, and the intraoperative input of protein were then recorded. Results A total of 419 patients were enrolled into the study. The control group consisted of 336 patients while 83 patients formed an AKI group based on the grading criteria of AKI. There were significant differences in chronic severe hepatitis (P=0.001), liver cancer (P=0.044), intraoperative input of sodium bicarbonate (P=0.019), input of red blood cell suspension (P=0.004), the input of blood plasma (P=0.043), intraoperative urine output (P=0.006), and preoperative creatinine (P=0.041) between the control and AKI group. Multivariate analysis indicated that chronic severe hepatitis (OR: 2.872; P=0.003) and preoperative creatinine (OR: 1.083; P=0.011) were independent risk factors for AKI in patients receiving liver transplantation. Conclusions Chronic severe hepatitis and preoperative creatinine may be potential risk factors for the occurrence of AKI after liver transplantation.
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Affiliation(s)
- Yingqi Chen
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Beijing, China
| | - Shanshan Mu
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Beijing, China
| | - Jing Wang
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Beijing, China
| | - Anshi Wu
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Beijing, China
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Liu Q, Gao K, Zheng C, Guo C. The Risk Factors for Perioperative Serum Albumin Variation in Pediatric Patients Undergoing Major Gastroenterology Surgery. Front Surg 2021; 7:627174. [PMID: 33585551 PMCID: PMC7873733 DOI: 10.3389/fsurg.2020.627174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 12/30/2020] [Indexed: 12/13/2022] Open
Abstract
Background: The albumin, a negative acute-phase protein, is important for perioperative morbidity, even in patients with normal preoperative levels. This study intend to determine the perioperative factors related with the postoperative reduction in serum albumin (ΔALB) and its influence on perioperative outcome in a pediatric general surgical cohort. Methods: This single-center retrospective review included 939 pediatric patients who underwent major gastroenterology surgery from August 2010 to August 2019. The patients were dichotomized into a high ΔALB group (≥14.6%) and a low ΔALB group (<14.6%) based on the mean value of ΔALB (14.6%). the independent risk factors for ΔALB, were explored using the propensity score matching to minimize potential selection bias and subjected to method multivariable logistic regression model. Furthermore, in 366 matched patients, the influences of operating time on perioperative outcomes were analyzed. Results: Among the 996 patients reviewed, 939 patient records were enrolled in the final analysis. Controlling for other factors, multivariable analysis showed that a high CRP on POD 3 or 4 [odds ratio (OR) = 2.36 (95% CI, 1.51–3.86); p = 0.007], a longer operating time [OR = 1.18 (95% CI, 1.00–1.53); p = 0.014), and the presence of Charcot's triad [OR = 1.73 (95% CI, 1.05–2.83); p = 0.031] were factors that predicted a high ΔALB level. A high ΔALB level was also related with gastrointestinal functional recovery delay, reflected by the postoperative defecation (p = 0.013) and bowel movement (p = 0.019) delay and the high occurrence of postoperative complications (16.1 vs. 10.9%, OR, 1.57; 95% CI, 1.02–2.41, P = 0.0026). Conclusions: The high ΔALB level was correlated with postoperative outcome. To obtain a safe recovery and discharge after a major abdominal operation, the above risk factors for ΔALB could be addressed in the perioperative period.
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Affiliation(s)
- Qingshuang Liu
- Department of Pediatric General and Neonatal Surgery, Children's Hospital, Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Engineering Research Center of Stem Cell Therapy, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Kai Gao
- Department of Pediatric General and Neonatal Surgery, Children's Hospital, Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Engineering Research Center of Stem Cell Therapy, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Chao Zheng
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Engineering Research Center of Stem Cell Therapy, Children's Hospital of Chongqing Medical University, Chongqing, China.,Department of Orthopedics, Children's Hospital, Chongqing Medical University, Chongqing, China
| | - Chunbao Guo
- Department of Pediatric General and Neonatal Surgery, Children's Hospital, Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Engineering Research Center of Stem Cell Therapy, Children's Hospital of Chongqing Medical University, Chongqing, China
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Joosten A, Lucidi V, Ickx B, Van Obbergh L, Germanova D, Berna A, Alexander B, Desebbe O, Carrier FM, Cherqui D, Adam R, Duranteau J, Saugel B, Vincent JL, Rinehart J, Van der Linden P. Intraoperative hypotension during liver transplant surgery is associated with postoperative acute kidney injury: a historical cohort study. BMC Anesthesiol 2021; 21:12. [PMID: 33430770 PMCID: PMC7798188 DOI: 10.1186/s12871-020-01228-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/27/2020] [Indexed: 12/12/2022] Open
Abstract
Background Acute kidney injury (AKI) occurs frequently after liver transplant surgery and is associated with significant morbidity and mortality. While the impact of intraoperative hypotension (IOH) on postoperative AKI has been well demonstrated in patients undergoing a wide variety of non-cardiac surgeries, it remains poorly studied in liver transplant surgery. We tested the hypothesis that IOH is associated with AKI following liver transplant surgery. Methods This historical cohort study included all patients who underwent liver transplant surgery between 2014 and 2019 except those with a preoperative creatinine > 1.5 mg/dl and/or who had combined transplantation surgery. IOH was defined as any mean arterial pressure (MAP) < 65 mmHg and was classified according to the percentage of case time during which the MAP was < 65 mmHg into three groups, based on the interquartile range of the study cohort: “short” (Quartile 1, < 8.6% of case time), “intermediate” (Quartiles 2–3, 8.6–39.5%) and “long” (Quartile 4, > 39.5%) duration. AKI stages were classified according to a “modified” “Kidney Disease: Improving Global Outcomes” (KDIGO) criteria. Logistic regression modelling was conducted to assess the association between IOH and postoperative AKI. The model was run both as a univariate and with multiple perioperative covariates to test for robustness to confounders. Results Of the 205 patients who met our inclusion criteria, 117 (57.1%) developed AKI. Fifty-two (25%), 102 (50%) and 51 (25%) patients had short, intermediate and long duration of IOH respectively. In multivariate analysis, IOH was independently associated with an increased risk of AKI (adjusted odds ratio [OR] 1.05; 95%CI 1.02–1.09; P < 0.001). Compared to “short duration” of IOH, “intermediate duration” was associated with a 10-fold increased risk of developing AKI (OR 9.7; 95%CI 4.1–22.7; P < 0.001). “Long duration” was associated with an even greater risk of AKI compared to “short duration” (OR 34.6; 95%CI 11.5-108.6; P < 0.001). Conclusions Intraoperative hypotension is independently associated with the development of AKI after liver transplant surgery. The longer the MAP is < 65 mmHg, the higher the risk the patient will develop AKI in the immediate postoperative period, and the greater the likely severity. Anesthesiologists and surgeons must therefore make every effort to avoid IOH during surgery.
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Affiliation(s)
- Alexandre Joosten
- Department of Anesthesiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium. .,Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Université Paris-Saclay, Paul Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), 12 Avenue Paul Vaillant Couturier, 94800, Villejuif, France.
| | - Valerio Lucidi
- Department of Digestive Surgery, Unit of Hepatobiliary Surgery and Liver Transplantation, Erasme hospital, Cliniques Universitaires de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Brigitte Ickx
- Department of Anesthesiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Luc Van Obbergh
- Department of Anesthesiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Desislava Germanova
- Department of Digestive Surgery, Unit of Hepatobiliary Surgery and Liver Transplantation, Erasme hospital, Cliniques Universitaires de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Antoine Berna
- Department of Anesthesiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Brenton Alexander
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Olivier Desebbe
- Department of Anesthesiology and Perioperative Medicine, Sauvegarde Clinic, Ramsay Santé, Lyon, France
| | - Francois-Martin Carrier
- Department of Anesthesiology, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Daniel Cherqui
- Department of Hepatobiliary Surgery, Paul Brousse Hospital, Villejuif, France
| | - Rene Adam
- Department of Hepatobiliary Surgery, Paul Brousse Hospital, Villejuif, France
| | - Jacques Duranteau
- Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Université Paris-Saclay, Paul Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), 12 Avenue Paul Vaillant Couturier, 94800, Villejuif, France
| | - Bernd Saugel
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Outcomes Research Consortium, Cleveland, Ohio, USA
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Joseph Rinehart
- Department of Anesthesiology and Perioperative Care, University of California Irvine, Irvine, California, USA
| | - Philippe Van der Linden
- Department of Anesthesiology, Brugmann Hospital, Université Libre de Bruxelles, Bruxelles, Belgium
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Park J, Cho S, Cho YJ, Choi HJ, Hong SH, Chae MS. Predictive Utility of Antithrombin III in Acute Kidney Injury in Living-Donor Liver Transplantation: A Retrospective Observational Cohort Study. Transplant Proc 2020; 53:111-118. [PMID: 33272652 DOI: 10.1016/j.transproceed.2020.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/07/2020] [Accepted: 10/01/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION This study was performed to determine the association between the serum level of antithrombin III (ATIII) level and the risk of acute kidney injury (AKI) in patients undergoing living-donor liver transplantation (LDLT). PATIENTS AND METHODS A total of 591 patients undergoing LDLT were retrospectively investigated and 14 patients were excluded because of a history of kidney dysfunction or missing data; 577 patients were finally enrolled in the study. The study population was divided into normal and low ATIII groups. Data on all laboratory variables, including ATIII, were collected on the day before surgery. RESULTS After LDLT, 143 patients developed AKI (24.8%). A lower ATIII was independently associated with postoperative AKI along with preoperative (diabetes mellitus) and intraoperative (mean heart rate, hourly urine output) factors. Based on the standard cutoff for normal ATIII (<70%), the probability of AKI was 2.8-fold higher in the low ATIII group than in the normal ATIII group. In addition, patients with low ATIII received blood transfusion products during the operation and underwent longer duration mechanical ventilation. CONCLUSIONS Preoperative ATIII measurement will help improve risk stratification for postoperative AKI development in patients undergoing LDLT.
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Affiliation(s)
- Jaesik Park
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seunghee Cho
- Department of Anesthesiology and Pain Medicine, Incheon St. Marys Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yun Jeong Cho
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ho Joong Choi
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Hyun Hong
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min Suk Chae
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Park J, Choi JH, Choi HJ, Hong SH, Park CS, Choi JH, Chae MS. Predictive role of vitamin B 12 in acute kidney injury in living donor liver transplantation: a propensity score matching analysis. BMJ Open 2020; 10:e038990. [PMID: 33191257 PMCID: PMC7668363 DOI: 10.1136/bmjopen-2020-038990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES We examine the association between vitamin B12 level and risk for acute kidney injury (AKI) in patients undergoing living donor liver transplantation (LDLT). DESIGN Retrospective observational cohort study. SETTING University hospital, from January 2009 to December 2018. PARTICIPANTS A total of 591 patients who underwent elective LDLT were analysed in this study. Those with a preoperative history of kidney dysfunction, vitamin B12 supplementation due to alcoholism, low vitamin B12 (<200 pg/mL) or missing laboratory data were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES The population was classified into AKI and non-AKI groups according to Kidney Disease Improving Global Outcomes (KDIGO) criteria, and associations between perioperative factors and AKI were analysed. After 1:1 propensity score (PS) matching, the association between high vitamin B12 (>900 pg/mL) and postoperative AKI was evaluated. RESULTS Preoperative vitamin B12 was higher in the AKI group. Potentially significant perioperative factors from univariate analyses were entered into multivariate analyses, including preoperative factors (vitamin B12, diabetes), intraoperative factors (hourly urine output) and donor graft fatty change in LDLT patients. PS matching analyses with adjustment using PS revealed that high serum vitamin B12 (>900 pg/mL) was associated with risk for AKI, and the risk was 2.8-fold higher in patients with high vitamin B12 than in those with normal vitamin B12. Higher vitamin B12 was also related to a higher AKI stage. In addition, inflammatory factors (C reactive protein, white blood cells and albumin) were associated with vitamin B12 level. CONCLUSIONS Our study may improve the accuracy of predicting postoperative AKI by introducing preoperative vitamin B12 into risk assessments for patients undergoing LDLT.
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Affiliation(s)
- Jaesik Park
- Anesthesiology and Pain Medicine, Catholic University of Korea College of Medicine, Seoul, The Republic of Korea
| | - Jung Hee Choi
- Anesthesiology and Pain Medicine, Catholic University of Korea College of Medicine, Seoul, The Republic of Korea
| | - Ho Joong Choi
- Surgery, Catholic University of Korea College of Medicine, Seoul, The Republic of Korea
| | - Sang Hyun Hong
- Anesthesiology and Pain Medicine, Catholic University of Korea College of Medicine, Seoul, The Republic of Korea
| | - Chul Soo Park
- Anesthesiology and Pain Medicine, Catholic University of Korea College of Medicine, Seoul, The Republic of Korea
| | - Jong Ho Choi
- Anesthesiology and Pain Medicine, Catholic University of Korea College of Medicine, Seoul, The Republic of Korea
| | - Min Suk Chae
- Anesthesiology and Pain Medicine, Catholic University of Korea College of Medicine, Seoul, The Republic of Korea
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Abstract
Despite substantial advances in anesthesia safety within the past decades, perioperative mortality remains a prevalent problem and can be considered among the top causes of death worldwide. Acute organ failure is a major risk factor of morbidity and mortality in surgical patients and develops primarily as a consequence of a dysregulated inflammatory response and insufficient tissue perfusion. Neurological dysfunction, myocardial ischemia, acute kidney injury, respiratory failure, intestinal dysfunction, and hepatic impairment are among the most serious complications impacting patient outcome and recovery. Pre-, intra-, and postoperative arrangements, such as enhanced recovery after surgery programs, can contribute to lowering the occurrence of organ dysfunction, and mortality rates have improved with the advent of specialized intensive care units and advances in procedures relating to extracorporeal organ support. However, no specific pharmacological therapies have proven effective in the prevention or reversal of perioperative organ injury. Therefore, understanding the underlying mechanisms of organ dysfunction is essential to identify novel treatment strategies to improve perioperative care and outcomes for surgical patients. This review focuses on recent knowledge of pathophysiological and molecular pathways leading to perioperative organ injury. Additionally, we highlight potential therapeutic targets relevant to the network of events that occur in clinical settings with organ failure.
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Affiliation(s)
- Catharina Conrad
- From the Department of Anesthesiology, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas.,Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Holger K Eltzschig
- From the Department of Anesthesiology, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas
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Lv H, Wei X, Yi X, Liu J, Lu P, Zhou M, An Y, Yi H. High-dose ulinastatin to prevent late-onset acute renal failure after orthotopic liver transplantation. Ren Fail 2020; 42:137-145. [PMID: 31984833 PMCID: PMC7034081 DOI: 10.1080/0886022x.2020.1717530] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose To compare the efficacy and safety of two distinct doses of ulinastatin on late-onset acute renal failure (LARF) following orthotopic liver transplantation (OLT). Methods The high-risk recipients that underwent OLT were divided into two groups according to ulinastatin dose: low-dose (LD) ulinastatin group, 0.8 million U/d; high-dose (HD) ulinastatin group, 1.6 million U/d. The primary outcome was the incidence of LARF, which was defined the newly onset acute kidney injury (AKI) stage III (KDIGO, 2012) within 7–28 post-transplant days. The second outcomes were early multiple organ retrieval assessments, length of hospital stay and safety events. Results A total of 174 recipients were included (LD ulinastatin group, n = 55; HD ulinastatin group, n = 119). There was no significant difference in the incidence of LARF between LD (8/55, 14.50%) and HD (9/119, 7.56%) ulinastatin groups (HD vs. LD, HR, 0.49; 95%CI, 0.17–1.37; p = .1295). Multivariate Cox proportion risk regression model revealed HD ulinastatin (HR, 0.57; 95%CI, 0.38–0.98; p = .0464) was an independent protective factor for LARF. Early lactate level, oxygenation, AKI stage, graft function, and sequential organ failure assessment [SOFA] score were significantly improved in HD ulinastatin group versus LD ulinastatin group. No significant adverse events were observed in either group. Conclusions Higher dose of ulinastatin (1.6 million U/d) might be preferable to prevent LARF after OLT, and it may contribute to the enhancement of early multiple organ recovery and thus attenuate the incidence of LARF.
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Affiliation(s)
- Haijin Lv
- Transplant and Surgical Intensive Care Unit, The 3rd Affiliated Hospital of Sun Yat-Sen University, Guangzhou, P.R. China
| | - Xuxia Wei
- Transplant and Surgical Intensive Care Unit, The 3rd Affiliated Hospital of Sun Yat-Sen University, Guangzhou, P.R. China
| | - Xiaomeng Yi
- Transplant and Surgical Intensive Care Unit, The 3rd Affiliated Hospital of Sun Yat-Sen University, Guangzhou, P.R. China
| | - Jianrong Liu
- Transplant and Surgical Intensive Care Unit, The 3rd Affiliated Hospital of Sun Yat-Sen University, Guangzhou, P.R. China
| | - Pinglan Lu
- Transplant and Surgical Intensive Care Unit, The 3rd Affiliated Hospital of Sun Yat-Sen University, Guangzhou, P.R. China
| | - Mi Zhou
- Transplant and Surgical Intensive Care Unit, The 3rd Affiliated Hospital of Sun Yat-Sen University, Guangzhou, P.R. China
| | - Yuling An
- Transplant and Surgical Intensive Care Unit, The 3rd Affiliated Hospital of Sun Yat-Sen University, Guangzhou, P.R. China
| | - Huimin Yi
- Transplant and Surgical Intensive Care Unit, The 3rd Affiliated Hospital of Sun Yat-Sen University, Guangzhou, P.R. China
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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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Effects of intraoperative hemodynamic management on postoperative acute kidney injury in liver transplantation: An observational cohort study. PLoS One 2020; 15:e0237503. [PMID: 32810154 PMCID: PMC7446917 DOI: 10.1371/journal.pone.0237503] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/23/2020] [Indexed: 12/28/2022] Open
Abstract
Background Intraoperative restrictive fluid management strategies might improve postoperative outcomes in liver transplantation. Effects of vasopressors within any hemodynamic management strategy are unclear. Methods We conducted an observational cohort study on adult liver transplant recipients between July 2008 and December 2017. We measured the effect of vasopressors infused at admission in the intensive care unit (ICU) and total intraoperative fluid balance. Our primary outcome was 48-hour acute kidney injury (AKI) and our secondary outcomes were 7-day AKI, need for postoperative renal replacement therapy (RRT), time to extubation in the ICU, time to ICU discharge and survival up to 1 year. We fitted models adjusted for confounders using generalized estimating equations or survival models using robust standard errors. We reported results with 95% confidence intervals. Results We included 532 patients. Vasopressors use was not associated with 48-hour or 7-day AKI but modified the effects of fluid balance on RRT and mortality. A higher fluid balance was associated with a higher need for RRT (OR = 1.52 [1.15, 2.01], p<0.001 for interaction) and lower survival (HR = 1.71 [1.26, 2.34], p<0.01 for interaction) only among patients without vasopressors. In patients with vasopressors, higher doses of vasopressors were associated with a higher mortality (HR = 1.29 [1.13, 1.49] per 10 μg/min of norepinephrine). Conclusion The presence of any vasopressor at the end of surgery was not associated with AKI or RRT. The use of vasopressors might modify the harmful association between fluid balance and other postoperative outcomes. The liberal use of vasopressors to implement a restrictive fluid management strategy deserves further investigation.
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Zhou J, Lyu L, Zhu L, Liang Y, Dong H, Chu H. Association of overweight with postoperative acute kidney injury among patients receiving orthotopic liver transplantation: an observational cohort study. BMC Nephrol 2020; 21:223. [PMID: 32527305 PMCID: PMC7291754 DOI: 10.1186/s12882-020-01871-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 05/25/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a common postoperative complication of orthotopic liver transplantation (OLT). So far, little attention has been paid on the association between overweight and AKI after OLT, and animal models or clinical studies have drawn conflicting conclusions. The objective of our study was to determine whether overweight (BMI [Body Mass Index] ≥ 25 kg/m2) is associated with an increased risk of AKI after OLT. METHODS This retrospective cohort study included 244 patients receiving OLT in the Affiliated Hospital of Qingdao University between January 1, 2017, and August 29, 2019. Preoperative, intraoperative, and postoperative data were collected retrospectively. The primary outcome was the development of AKI as defined by Kidney Disease, Improving Global Outcome (KIDGO) staging system. Logistic regression analysis was used to determine the relationship between overweight and the occurrence of postoperative AKI. Data analysis was conducted from September to October 2019, revision in April 2020. RESULTS Among 244 patients receiving OLT (mean [standard deviation] age, 54.1 [9.6] years; 84.0% male) identified, 163 patients (66.8%) developed postoperative AKI. Overweight (BMI ≥ 25 kg/m2) was associated with a higher rate of postoperative severe AKI (stage 2/3) compared with normal weight (18.5 ≤ BMI < 25 kg/m2) (41 [47.7%] vs 39 [28.7%]; adjusted odds ratio [OR], 2.539; 95% confidence interval [CI], 1.389-4.642; P = 0.002). Furthermore, patients with obese were at even higher risk of postoperative severe AKI after controlling for confounding factors (adjusted OR: 3.705; 95% CI: 1.108-12.388; P = 0.033). CONCLUSIONS Overweight is independently associated with an increased risk of postoperative severe AKI among patients receiving OLT. The association of BMI with severe AKI after OLT is J-shaped.
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Affiliation(s)
- Jian Zhou
- Department of Anesthesiology, Qingdao University Medical College, Qingdao, China
| | - Lin Lyu
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao, 266100, Shandong Province, China
| | - Lin Zhu
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao, 266100, Shandong Province, China
| | - Yongxin Liang
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao, 266100, Shandong Province, China
| | - He Dong
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao, 266100, Shandong Province, China
| | - Haichen Chu
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao, 266100, Shandong Province, China.
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Peng JC, Li YJ, Wang JM, Zhu ML, Gao Y. Incidence of chronic kidney disease after orthotopic liver transplantation in a Chinese cohort. Clin Exp Nephrol 2020; 24:806-812. [PMID: 32504202 DOI: 10.1007/s10157-020-01910-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 05/29/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Kidney dysfunction frequently occurred after orthotopic liver transplantation (OLT). Chronic renal disease (CKD) is a complicated problem and is associated with increased mortality. The aim of this study is to find the risk factors for the incidence of CKD at 1 year after OLT in China. METHODS From January 2017 to December 2017, we retrospectively assessed 280 recipients in our single center. Chronic renal failure was defined as estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 for 3 months, regardless of the presence or absence of structural kidney damage. Cox proportional hazard model was used to identify the factors to the incidence of CKD after liver transplantations. Kaplan-Meier plots with log-rank test were presented to evaluate patient survival time in those with and without CKD. RESULTS With a median follow-up of 17.4 months, 48 patients developed CKD after liver transplantations, representing 17.1% of the cohort. The cox-regression model showed that recipients age (HR = 1.097, P < 0.01), AKI (HR = 1.542, P < 0.01) and MELD score (HR = 1.077, P < 0.01) were significantly associated with the development of post-transplant CKD at 1 year. Recipient survival at 1 year was significantly worse in recipients with CKD compared to those without CKD (P < 0.01) after adjustment by age and gender. CONCLUSION Our findings suggested that age, AKI and MELD score were associated with the incidence of CKD 1 year after OLT in a Chinese cohort. Recipients with CKD were associated with worse survival.
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Affiliation(s)
- Jiang-Chen Peng
- Department of Critical Care, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China
| | - Yu- Jie Li
- Department of Critical Care, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China
| | - Jie -Min Wang
- Department of Critical Care, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China
| | - Ming-Li Zhu
- Department of Critical Care, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China.
| | - Yuan Gao
- Department of Critical Care, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China.
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Kollmann D, Neong SF, Rosales R, Hansen BE, Sapisochin G, McCluskey S, Bhat M, Cattral MS, Lilly L, McGilvray ID, Ghanekar A, Grant DR, Selzner M, Wong FSH, Selzner N. Renal Dysfunction After Liver Transplantation: Effect of Donor Type. Liver Transpl 2020; 26:799-810. [PMID: 32189415 PMCID: PMC7317208 DOI: 10.1002/lt.25755] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 01/27/2020] [Accepted: 02/10/2020] [Indexed: 12/15/2022]
Abstract
Recipients of donation after circulatory death (DCD) grafts are reportedly at higher risk of developing renal dysfunction after liver transplantation (LT). We compared the development of acute kidney injury (AKI) and chronic kidney disease (CKD) after LT in recipients of DCD versus donation after brain death (DBD) or living donor liver transplantation (LDLT) livers. Adult recipients of DBD, LDLT, and DCD between 2012 and 2016 at Toronto General Hospital were included. AKI was defined as a post-LT increase of serum creatinine (sCr) ≥26.5 µmol/L within 48 hours or a ≥50% increase from baseline, and CKD was defined as an estimated glomerular filtration rate <60 mL/minute for >3 months. A total of 681 patients (DCD, n = 57; DBD, n = 446; and LDLT, n = 178) with similar baseline comorbidities were included. Perioperative AKI (within the first 7 postoperative days) was observed more frequently in the DCD group (61%; DBD, 40%; and LDLT, 44%; P = 0.01) and was associated with significantly higher peak AST levels (P < 0.001). Additionally, patients in the DCD group had a significantly higher peak sCr (P < 0.001) and a trend toward higher rates of AKI stage 3 (DCD, 33%; DBD, 21%; LDLT, 21%; P = 0.11). The proportions of recovery from AKI (DCD, 77%; DBD, 72%; LDLT, 78%; P = 0.45) and patients developing CKD (DCD, 33%; DBD, 32%; LDLT, 32%; P = 0.99) were similar. Nevertheless, patients who received DCD or DBD LT and required perioperative renal replacement therapy showed significantly lower patient survival in multivariate analysis (hazard ratio, 7.90; 95% confidence interval, 4.51-13.83; P < 0.001). In conclusion, recipients of DCD liver grafts experience higher rates of short-term post-LT renal dysfunction compared with DBD or LDLT. Additional risk factors for the development of severe kidney injury, such as high Model for End-Stage Liver Disease score, massive transfusions, or donor age ≥60 years should be avoided.
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Affiliation(s)
- Dagmar Kollmann
- Multi‐Organ Transplant ProgramToronto General HospitalTorontoONCanada,Department of SurgeryMedical University of ViennaViennaAustria
| | - Shuet Fong Neong
- Multi‐Organ Transplant ProgramToronto General HospitalTorontoONCanada
| | - Roizar Rosales
- Multi‐Organ Transplant ProgramToronto General HospitalTorontoONCanada
| | - Bettina E. Hansen
- Institute of Health PolicyManagement and EvaluationUniversity of TorontoTorontoONCanada,Toronto Centre for Liver DiseaseToronto General HospitalTorontoONCanada
| | | | - Stuart McCluskey
- Department of Anesthesia and Pain ManagementToronto General HospitalTorontoONCanada
| | - Mamatha Bhat
- Multi‐Organ Transplant ProgramToronto General HospitalTorontoONCanada
| | - Mark S. Cattral
- Multi‐Organ Transplant ProgramToronto General HospitalTorontoONCanada
| | - Les Lilly
- Multi‐Organ Transplant ProgramToronto General HospitalTorontoONCanada
| | - Ian D. McGilvray
- Multi‐Organ Transplant ProgramToronto General HospitalTorontoONCanada
| | - Anand Ghanekar
- Multi‐Organ Transplant ProgramToronto General HospitalTorontoONCanada
| | - David R. Grant
- Multi‐Organ Transplant ProgramToronto General HospitalTorontoONCanada
| | - Markus Selzner
- Multi‐Organ Transplant ProgramToronto General HospitalTorontoONCanada
| | - Florence S. H. Wong
- Division of GastroenterologyToronto General HospitalUniversity Health NetworkToronto General HospitalTorontoONCanada
| | - Nazia Selzner
- Multi‐Organ Transplant ProgramToronto General HospitalTorontoONCanada
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The Association Between Vena Cava Implantation Technique and Acute Kidney Injury After Liver Transplantation. Transplantation 2020; 104:e308-e316. [DOI: 10.1097/tp.0000000000003331] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Abstract
Postoperative acute kidney injury (AKI) is a common complication of surgery that is associated with significant adverse outcomes, including increased morbidity and mortality. The perioperative burden of AKI risk factors is complex and potentially large, including high-risk nephrotoxic medications, hypotension, hypovolemia, radiologic contrast, anemia, and surgery-specific factors. Understanding the pathogenesis, risk factors, and potential cumulative impact of perioperative nephrotoxic exposures is particularly important in the prevention and reduction of perioperative AKI. This review outlines the possible strategies to reduce perioperative nephrotoxicity and the development of postoperative AKI.
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Affiliation(s)
- Heather Walker
- Division of Population Health and Genomics, University of Dundee, Dundee, United Kingdom; Renal Unit, Ninewells Hospital, Dundee, United Kingdom
| | - Samira Bell
- Division of Population Health and Genomics, University of Dundee, Dundee, United Kingdom; Renal Unit, Ninewells Hospital, Dundee, United Kingdom.
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