Pre- and intraoperative predictors of acute kidney injury after liver transplantation

doi:10.12998/wjcc.v8.i18.4034

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World Journal of Clinical Cases

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

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World J Clin Cases. Sep 26, 2020; 8(18): 4034-4042
Published online Sep 26, 2020. doi: 10.12998/wjcc.v8.i18.4034

Table 1 Characteristic of the total patient cohort with differences between acute kidney injury and non-acute kidney injury patients within first 7 d after liver transplantation

Characteristics	All (n = 205)	AKI (n = 93)	non-AKI (n = 112)	P value
Male/female, n (%)	151 (73.7)/54 (26.3)	72 (77.4)/21 (22.6)	79 (70.5)/33 (77.4)	0.265
Age, yr	57 ± 10	56.51 ± 8.83	56.87 ± 11.38	0.803
BMI, kg/m²	26.26 ± 4.46	27.51 ± 4.93	25.22 ± 3.76	< 0.001
Etiology of liver disease¹
Alcohol-related, n (%)	108 (52.7)	54 (58.1)	54 (48.2)	0.16
Viral diseases, n (%)
Hepatitis C, n (%)	31 (15.1)	15 (16.1)	16 (14.3)	0.714
Hepatitis B, n (%)	17 (18.3)	5 (5.4)	12 (10.7)	0.168
Autoimmune diseases n (%)	19 (19.3)	7 (7.5)	12 (10.7)	0.433
Other liver disease n (%)	33 (16.1)	14 (15.1)	19 (17)	0.711
Co-morbidites, n (%)
Tumors, n (%)	74 (36.1)	27 (29)	47 (42)	0.055
Arterial hypertension, n (%)	57 (27.8)	24 (25.8)	33 (29.5)	0.561
CKD, n (%)	21 (10.2)	7 (7.5)	14 (12.5)	0.242
T2D, n (%)	58 (28.3)	27 (29)	31 (27.7)	0.83
Laboratory values preLT, mean ± SD
Hb (g/L)	114.26 ± 22.84	110.76 ± 22.6	117.17 ± 22.72	0.045
Bilirubin, µmol/L	40 (23-103)	48.5 (26.8-112.5)	33.5(21.3-88.5)	0.075
Creatinine, µmol/L	98.28 ± 75.05	96.16 ± 64.08	100.04 ± 83.31	0.714
INR	1.61 ± 0.56	1.68 ± 0.56	1.55 ± 0.55	0.115
Na, mmol/L	135.3 ± 4.87	134.78 ± 5.27	135.73 ± 4.48	0.18
eGFR, mL/min/1.73 m²	90.61 ± 47.27	90.64 ± 51.59	90.58 ± 43.59	0.993
MELD	16.94 ± 7.58	17.66 ± 7.2	16.35 ± 7.86	0.22
MELD-Na	19.39 ± 7.76	20.45 ± 7.32	18.49 ± 8.04	0.08
Intraoperative parameters
FFP, mL	2112.19 ± 1393.22	2388.4 ± 1389.4	1873.2 ± 1358.2	0.01
Cristalloids, mL	5020.67 ± 1506.97	4941.54 ± 1281.1	5090.58 ± 1684.74	0.493
Colloids, mL	1724.77 ± 925.12	1891.76 ± 913.24	1578.65 ± 914.9	0.018
Albumins, mL	741.79 ± 378.36	823.08 ± 404.65	670.67 ± 340.02	0.005
CIT, h	437.67 ± 135.74	452.3 ± 136.26	427.42 ± 135.31	0.304
WIT, min	27.29 ± 6.93	28 ± 7.72	26.59 ± 6.13	0.425
RBCs, L	5.7 (3.7-8.2)	6 (4.9-9.9)	4.71 (3-7.5)	0.001

¹3 pts had multiple etiologies. CIT: Cold ishemia time; CKD: Chronic kidney disease eGFR: estimated glomerular filtration rate; FFP: Fresh frozen plasma; Hb: Hemoglobin; INR: International normalised ratio; MELD: Model of End-stage Liver Disease; Na: Sodium; RBCs: Red blood cells; T2D: Type 2 diabetes; WIT: Warm ishemia time; a Median with interquartile range is shown and P value was calculated by Mann Whitney test, for all other numerical variables mean and standard deviation are shown and P value was calculated by Student’s t test. AKI: Acute kidney injury.

Table 2 Distribution of stages of acute kidney injury after liver transplantation

	n (%)
No AKI	112
AKI stage 1	54 (58.06)
AKI stage 2	24 (25.81)
AKI stage 3	15 (16.13)
Postop HD	5 (5.38)
Severe AKI (stage 2/3)	39 (41.94)
Overall AKI	93 (45.36)

AKI: Acute kidney injury.

Table 3 Univariate and multivariate logistic regression; factors associated with acute kidney injury occurrence within 7 d after liver transplantation

Characteristics	OR	95%CI (OR)	P value	OR	95%CI (OR)	P value
RBC^a	1.84	1.3-2.6	0.001	1.66	1.09-2.53	0.018
BMI	1.13	1.06–1.21	< 0.001	1.14	1.05-1.24	0.001
Hb	0.99	0.98–1.00	0.047	0.98	0.97-1	0.053
NaMELD	1.03	0.99–1.07	0.082	0.93	0.83-1.04	0.195
Tumor, yes vs no	0.57	0.32–1.02	0.056	1.51	0.71-3.23	0.288
HBV, yes vs no	0.47	0.16–1.40	0.176	0.98	0.24-4.01	0.976
Bilirubin^a	1.14	0.97–1.34	0.123	1.39	0.96-2.02	0.079
ALC, yes vs no	1.49	0.86–2.59	0.16	1.47	0.69-3.14	0.315
Na	0.96	0.91–1.02	0.182	0.96	0.88-1.05	0.415
INR	1.49	0.90–2.47	0.119	0.87	0.35-2.15	0.762

^aVariables were logarithmized (base 2) to achieve normal distribution; Variables FFP (fresh frozen plasma), colloids, and albumins were not included into analysis because of high correlation with RBC – to avoid multicollinearity; Nagelkerke R² = 0.231. ALC: Alcohol related liver disease; BMI: Body mass index; Hb: Haemoglobin; HBV: Hepatitis B virus; INR: International normalised ratio; MELD: Model of End-stage Liver Disease; Na: Sodium; RBCs: Red blood cells.

Citation: Mrzljak A, Franusic L, Pavicic-Saric J, Kelava T, Jurekovic Z, Kocman B, Mikulic D, Budimir-Bekan I, Knotek M. Pre- and intraoperative predictors of acute kidney injury after liver transplantation. World J Clin Cases 2020; 8(18): 4034-4042
URL: https://www.wjgnet.com/2307-8960/full/v8/i18/4034.htm
DOI: https://dx.doi.org/10.12998/wjcc.v8.i18.4034