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Br J Anaesth. 2015 Jun;114(6):919-26. doi: 10.1093/bja/aeu556. Epub 2015 Feb 10.

Acute kidney injury following orthotopic liver transplantation: incidence, risk factors, and effects on patient and graft outcomes.

Author information

1
Department of Anesthesiology.
2
Department of Medicine.
3
Department of Medicine Department of Biostatistics.
4
Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA kellumja@upmc.edu.

Abstract

BACKGROUND:

Liver transplant recipients frequently develop acute kidney injury (AKI), but the predisposing factors and long-term consequences of AKI are not well understood. The aims of this study were to identify predisposing factors for early post-transplant AKI and the impact of AKI on patient and graft survival and to construct a model to predict AKI using clinical variables.

METHODS:

In this 5-year retrospective study, we analysed clinical and laboratory data from 424 liver transplant recipients from our centre.

RESULTS:

By 72 h post-transplant, 221 patients (52%) had developed AKI [according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria]. Predisposing factors for development of AKI were female sex, weight (>100 kg), severity of liver disease (Child-Pugh score), pre-existing diabetes mellitus, number of units of blood or fresh frozen plasma transfused during surgery, and non-alcoholic steatohepatitis as the aetiology of end-stage liver disease (P≤0.05). Notably, preoperative serum creatinine (SCr) was not a significant predisposing factor. After fitting a forward stepwise regression model, female sex, weight >100 kg, high Child-Pugh score, and diabetes remained significantly associated with the development of AKI within 72 h (P≤0.05). The area under the receiver operator characteristic curve for the final model was 0.71. The incidence of new chronic kidney disease and requirement for dialysis at 3 months and 1 yr post-transplant were significantly higher among patients who developed AKI.

CONCLUSIONS:

Development of AKI within the first 72 h after transplant impacted short-term and long-term graft survival.

KEYWORDS:

acute kidney injury; epidemiology; liver transplantation; outcomes

PMID:
25673576
DOI:
10.1093/bja/aeu556
[Indexed for MEDLINE]
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