Incidence and risk factors for early renal dysfunction after liver transplantation

doi:10.5500/wjt.v6.i1.220

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World Journal of Transplantation

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2220-3230

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Transplant. Mar 24, 2016; 6(1): 220-232
Published online Mar 24, 2016. doi: 10.5500/wjt.v6.i1.220

Table 1 Univariate analysis for severity of post orthotopic liver transplantation acute kidney injury

Variable	Whole group (n = 187)	Group 1 (n = 78)	Group 2 (n = 76)	Group 3 (n = 38)	Group 4 (n = 25)	P value between groups
Preoperative
Age (yr)	56 ± 10	54 ± 10	56 ± 10	58 ± 9	57 ± 12	0.055
Sex (male)	147 (79)	61 (78)	32 (70)	33 (87)	21 (84)	0.410
BMI (kg/m²)	26 ± 4.5	25 ± 4	26 ± 5	26 ± 5	26 ± 5.0	0.055
Hospital stay (d)	3 ± 8	2.2 ± 4.8	4.2 ± 12.9	2.7 ± 7.9	6.4 ± 9.6	0.150
Bilirubin (mg/L)	25 (12-66)	17.4 (8.7-44.8)	23.2 (13.1-60.6)	32.3 (15.8-64.9)	56.3 (23.1-115.0)	< 0.0001
Creatinine (mg/L)	9.5 (7.4-12.3)	7 (6.6-9.3)	10.4 (8.0-12.7)	11.5 (9.3-14.5)	13.4 (6.6-16.0)	< 0.0001
Urea (g/L)	0.47 ± 0.35	0.34 (0.20-0.42)	0.40 (0.30-0.59)	0.42 (0.33-0.68)	0.64 (0.38-0.92)	< 0.0001
Ascites	138 (73)	50 (64)	37 (80)	30 (79)	21 (84)	0.015
β blockers	67 (37)	24 (31)	18 (39)	17 (46)	8 (33)	0.400
ACEI	18 (10)	8 (11)	4 (9)	4 (11)	2 (8)	0.770
NSAIDs	5 (3)	1 (1)	2 (4)	1 (3)	1 (4)	0.480
Prior bacterial infection	62 (33)	16 (20)	18 (39.1)	13 (34.2)	15 (60)	0.0007
Intraoperative
DCD	63 (34)	25 (32)	17 (37)	12 (32)	9 (36)	0.790
Infection	50 (27)	17 (22)	12 (26)	13 (34)	8 (32)	0.140
Vasopressors	86 (46)	18 (23)	25 (54)	25 (66)	18 (72)	< 0.0001
Surgical revision	45 (24)	12 (15)	12 (26)	11 (29)	10 (40)	0.0087
Transfusion	169 (90)	66 (85)	44 (96)	37 (97)	22 (88)	0.060
Postoperative
Lactates D1 (mg/L)	434 ± 230	394 (270-509)	375 (279-484)	428 (283-527)	435 (334-711)	0.200
Minimum hemoglobin (g/dL)	8.0 (7.0-9.2)	8.9 (7.8-10.3)	7.7 (6.7-8.5)	7.55 (6.8-8.5)	6.7 (6.5-8.0)	< 0.0001
Bilirubin peak (mg/L)	40 (23-77.6)	37 (18-77)	32 (24-82)	51 (37-73)	60 (33-128)	0.006
ASAT (UI/L)	733 (372-1248)	554 (333-966)	804 (472-1988)	875 (399-1300)	822 (505-2458)	0.001
ALAT (UI/L)	617 (380-1068)	569 (332-941)	698 (399-1085)	546 (397-1113)	695 (407-1133)	0.260
Urea (g/L)	0.88 (0.6-1.3)	0.57 (0.46-0.69)	0.97 (0.80-1.14)	1.38 (1.21-1.64)	1.87 (1.52-2.18)	< 0.0001
Mechanical ventilation > 24 h	56 (30)	18 (23)	9 (20)	16 (42)	13 (52)	0.0026
Mechanical ventilation days	1 (1-2)	1 (1-1)	1 (1-1)	1 (1-2)	2 (1-2)	0.0014
RRT	20 (11)	4 (5)	2 (4)	1 (3)	13 (52)	< 0.0001
ICU stay (d)	3 (2-5)	2 (2-4)	3 (2-4)	5 (4-7)	6 (4-13)	0.0046
Tacrolimus	177 (95)	77 (99)	43 (94)	35 (92)	22 (92)	0.089
Cyclosporin	21 (11)	5 (6)	7 (15)	6 (16)	3 (13)	0.170
Additional immunosuppressant	185 (98)	77 (99)	46 (100)	38 (100)	24 (96)	0.550
Transfusion RCC D0 (U)	1 (0-3)	0 (0-2)	2 (0-4)	2 (1-5)	2 (1-5)	0.0007
Transfusion RCC D1 (U)	0 (0-1)	0 (0-0)	0 (0-1.5)	0 (0-2)	0 (0-4)	< 0.0001
Transfusion RCC D7 (U)	2 (0-5)	0 (0-3)	3 (1-6)	4 (2-7)	4 (2-12)	< 0.0001
Transfusion FFP D0 (U)	4 (2-6)	3 (0-6)	4 (2-7)	6 (3-9)	6 (3-8)	0.0031
Transfusion FFP D1 (U)	0 (0-2)	0 (0-0)	0 (0-2)	2 (0-3)	2 (0-4)	< 0.0001
Transfusion FFP D7 (U)	6 (2-10)	4 (1-6)	6 (2.5-10)	8 (4-11)	8 (6-15)	< 0.0001
Transfusion platelets D0 (CUP)	1 (0-1)	0 (0-1)	1 (0-1)	1 (0-1)	1 (1-2)	0.0008
Transfusion platelets D1 (CUP)	0 (0-0)	0 (0-0)	0 (0-0)	0 (0-0)	0 (0-1)	0.0022
Transfusion platelets D7 (CUP)	1 (0-2)	0 (0-1)	1 (0-2.5)	1 (0-2)	2 (1-4)	< 0.0001

BMI: Body mass index; ACEI: Angiotensin-converting enzyme inhibitors; NSAIDs: Non-steroidal anti-inflammatory drugs; DCD: Donation after circulatory death; ASAT: Aspartate aminotransferase; ALAT: Alanine amino transferase; RRT: Renal replacement therapy; ICU: Intensive care unit.

Table 2 Multivariate analysis for increased post orthotopic liver transplantation serum creatinine level

	OR	95%CI	P value
BMI (kg/m²)	1.10	1.03-1.18	0.0044
Preoperative increased creatinine (ln - mg/L)	11.07	5.28-23.23	< 0.0001
Vasopressors use	3.31	1.75-6.29	0.0002
Postoperative minimum Hemoglobin (ln - g/dL)	0.06	0.01-0.29	0.0005
Postoperative bilirubin peak (ln - mg/L)	1.44	1.01-2.05	0.044

BMI: Body mass index; ln: Natural logarithm.

Table 3 Post hoc multivariate analysis highlighting the effect of anti-hemorragic treatment strategy on acute kidney injury occurrence

Risk not being into the 1^th group in multivariate analysis	OR	95%CI	P value
Antihemorragic treatment period	3.36	1.44-7.85	0.005
Preoperative increased creatinine (ln - mg/L)	1.36	1.20-1.54	< 0.0001
Bleeding (100 mL)	1.03	1.01-1.06	0.011

ln: Natural logarithm.

Citation: Wiesen P, Massion PB, Joris J, Detry O, Damas P. Incidence and risk factors for early renal dysfunction after liver transplantation. World J Transplant 2016; 6(1): 220-232
URL: https://www.wjgnet.com/2220-3230/full/v6/i1/220.htm
DOI: https://dx.doi.org/10.5500/wjt.v6.i1.220