Copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Pre- and intraoperative predictors of acute kidney injury after liver transplantation
Anna Mrzljak, Lucija Franusic, Jadranka Pavicic-Saric, Tomislav Kelava, Zeljka Jurekovic, Branislav Kocman, Danko Mikulic, Ivan Budimir-Bekan, Mladen Knotek
Anna Mrzljak, Mladen Knotek, Department of Medicine, Merkur University Hospital, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
Lucija Franusic, General Hospital Dubrovnik, Dubrovnik 20000, Croatia
Jadranka Pavicic-Saric, Department of Anesthesiology and Intensive Medicine, Merkur University Hospital, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
Tomislav Kelava, Laboratory for Molecular Immunology, Croatian Institute for Brain Research, University of Zagreb, School of Medicine, Zagreb 10000, Croatia
Zeljka Jurekovic, Department of Medicine, Merkur University Hospital, Zagreb 10000, Croatia
Branislav Kocman, Danko Mikulic, Ivan Budimir-Bekan, Department of Surgery, Merkur University Hospital, Zagreb 10000, Croatia
Author contributions: Mrzljak A made contributions to the conception and design of the study, drafted and wrote the manuscript. Franusic L, Pavicic-Saric J, and Budimir-Bekan I collected the data; Kelava T analyzed the data. Jurekovic Z, Kocman B, and Mikulic D critically revised the manuscript; Knotek M wrote and critically revised the manuscript; all authors read and approved the final manuscript.
Supported by the Croatian Science Foundation grant“The Role of Notch Signalling Pathway in Pathogenesis of Hepatic Fibrosis”, No. UIP-2017-05-1965.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Merkur University Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Anna Mrzljak, MD, PhD, Associate Professor, Department of Medicine, Merkur University Hospital, School of Medicine, University of Zagreb, Zajceva 19, Zagreb 10000, Croatia.
anna.mrzljak@mef.hr
Received: April 18, 2020
Peer-review started: April 18, 2020
First decision: June 8, 2020
Revised: June 8, 2020
Accepted: September 3, 2020
Article in press: September 3, 2020
Published online: September 26, 2020
Processing time: 156 Days and 15.2 Hours
ARTICLE HIGHLIGHTS
Research background
Acute kidney injury (AKI) after liver transplantation (LT) is a frequent and multifactorial event related to increased morbidity and mortality.
Research motivation
Risk factors for AKI after LT still need to be clarified.
Research objectives
To identify the predictors of acute kidney injury after liver transplantation.
Research methods
The frequency and pre- and intraoperative predictors of AKI within the first 7 d after LT were evaluated in adult liver transplant candidates in a single LT center in Croatia. AKI was defined according to the Kidney Disease: Improving Global Outcomes criteria.
Research results
Out of 205 patients, 45.36% developed AKI, and the majority of them (58.06%) had stage 1. Only 5.38% of patients required renal replacement therapy after LT. Pre-LT body mass index (OR = 1.1, 95%CI: 1.05-1.24) and red blood cell transfusion (OR = 1.66, 95%CI: 1.09-2.53) were identified as independent predictors of early post-LT AKI occurrence. 30-d survival after LT was significantly better for patients without AKI (P = 0.01).
Research conclusions
Early AKI after LT is a frequent event that negatively impacts short-term survival. The pathogenesis of AKI is multifactorial, but pre-LT BMI and intraoperative volume shifts are major contributors.
Research perspectives
Acute kidney injury, as a risk factor for mortality after LT, needs more investigation. Although it is clear from our results that the patients who developed AKI had lower 30-d survival, further research is required to assess whether AKI is an independent causative factor contributing to decreased survival. Similarly, the long-term risk of developing CKD needs to be evaluated in patients with post-transplant kidney injury.
