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2017 ; 9
(18
): 823-832
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Early acute kidney injury after liver transplantation: Predisposing factors and
clinical implications
#MMPMID28706581
Rahman S
; Davidson BR
; Mallett SV
World J Hepatol
2017[Jun]; 9
(18
): 823-832
PMID28706581
show ga
AIM: To investigate the additional clinical impact of hepatic ischaemia
reperfusion injury (HIRI) on patients sustaining acute kidney injury (AKI)
following liver transplantation. METHODS: This was a single-centre retrospective
study of consecutive adult patients undergoing orthotopic liver transplantation
(OLT) between January 2013 and June 2014. Early AKI was identified by measuring
serum creatinine at 24 h post OLT (> 1.5 × baseline) or by the use of continuous
veno-venous haemofiltration (CVVHF) during the early post-operative period.
Patients with and without AKI were compared to identify risk factors associated
with this complication. Peak serum aspartate aminotransferase (AST) within 24 h
post-OLT was used as a surrogate marker for HIRI and severity was classified as
minor (< 1000 IU/L), moderate (1000-5000 IU/L) or severe (> 5000 IU/L). The
impact on time to extubation, intensive care length of stay, incidence of chronic
renal failure and 90-d mortality were examined firstly for each of the two
complications (AKI and HIRI) alone and then as a combined outcome. RESULTS: Out
of the 116 patients included in the study, 50% developed AKI, 24% required CVVHF
and 70% sustained moderate or severe HIRI. Median peak AST levels were 1248 IU/L
and 2059 IU/L in the No AKI and AKI groups respectively (P = 0.0003).
Furthermore, peak serum AST was the only consistent predictor of AKI on
multivariate analysis P = 0.02. AKI and HIRI were individually associated with a
longer time to extubation, increased length of intensive care unit stay and
reduced survival. However, the patients who sustained both AKI and moderate or
severe HIRI had a longer median time to extubation (P < 0.001) and intensive care
length of stay (P = 0.001) than those with either complication alone. Ninety-day
survival in the group sustaining both AKI and moderate or severe HIRI was 89%,
compared to 100% in the groups with either or neither complication (P = 0.049).
CONCLUSION: HIRI has an important role in the development of AKI post-OLT and has
a negative impact on patient outcomes, especially when occurring alongside AKI.
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