1. Acute kidney injury following orthotopic liver transplantation: incidence, risk factors, and effects on patient and graft outcomes
- Author
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Ibtesam A. Hilmi, Tetsuro Sakai, C.-C. H. Chang, Raymond M. Planinsic, Charles D. Boucek, Daniela Damian, Ali Al-Khafaji, and John A. Kellum
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Liver transplantation ,urologic and male genital diseases ,End Stage Liver Disease ,Liver disease ,Postoperative Complications ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,Diabetes mellitus ,medicine ,Humans ,Dialysis ,Retrospective Studies ,business.industry ,Incidence ,Graft Survival ,Acute kidney injury ,Acute Kidney Injury ,Middle Aged ,medicine.disease ,Survival Analysis ,female genital diseases and pregnancy complications ,Liver Transplantation ,Surgery ,Transplantation ,Treatment Outcome ,Anesthesiology and Pain Medicine ,Female ,Hemodialysis ,business ,Algorithms ,Immunosuppressive Agents ,Kidney disease - 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.
- Published
- 2015