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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 14, 2016; 22(42): 9314-9323
Published online Nov 14, 2016. doi: 10.3748/wjg.v22.i42.9314
Acute kidney injury and post-reperfusion syndrome in liver transplantation
Ilaria Umbro, Francesca Tinti, Irene Scalera, Felicity Evison, Bridget Gunson, Adnan Sharif, James Ferguson, Paolo Muiesan, Anna Paola Mitterhofer
Ilaria Umbro, Francesca Tinti, Anna Paola Mitterhofer, Department of Clinical Medicine, Nephrology and Dialysis B, Sapienza University of Rome, 00185 Rome, Italy
Ilaria Umbro, Francesca Tinti, Irene Scalera, James Ferguson, Paolo Muiesan, The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, United Kingdom
Felicity Evison, Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, United Kingdom
Bridget Gunson, National Institute for Health Research Birmingham Liver Biomedical Research Unit, the Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, United Kingdom
Bridget Gunson, the Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TH, United Kingdom
Adnan Sharif, Department of Nephrology and Transplantation, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, United Kingdom
Author contributions: Umbro I and Mitterhofer AP wrote the paper; Tinti F, Scalera I, Evison F and Gunson B performed literature search, analysis and interpretation of data; Sharif A and Ferguson J contributed to conception and design of the study; Muiesan P and Mitterhofer AP designed the research and made critical revisions related to important intellectual content of the manuscript.
Supported by An international research grant 2014 of the Italian Society of Nephrology; The study sponsor provided logistic support but had no role in the collection and analysis of data or in the writing of the review and in the decision to submit the paper for publication; The study also received support from the NIHR Birmingham Liver Biomedical Research Unit; The opinions expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.
Conflict-of-interest statement: Authors declare no conflict of interest for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
Correspondence to: Anna Paola Mitterhofer, MD, PhD, FEBTM, Associate Professor, Department of Clinical Medicine, Nephrology and Dialysis B, Sapienza University of Rome, Viale dell’Università 37, 00185 Rome, Italy. annapaola.mitter@uniroma1.it
Telephone: +39-6-49972089 Fax: +39-6-49972089
Received: June 29, 2016
Peer-review started: July 1, 2016
First decision: August 8, 2016
Revised: September 10, 2016
Accepted: September 28, 2016
Article in press: September 28, 2016
Published online: November 14, 2016
Processing time: 136 Days and 11.5 Hours
Abstract

In the past decades liver transplantation (LT) has become the treatment of choice for patients with end stage liver disease (ESLD). The chronic shortage of cadaveric organs for transplantation led to the utilization of a greater number of marginal donors such as older donors or donors after circulatory death (DCD). The improved survival of transplanted patients has increased the frequency of long-term complications, in particular chronic kidney disease (CKD). Acute kidney injury (AKI) post-LT has been recently recognized as an important risk factor for the occurrence of de novo CKD in the long-term outcome. The onset of AKI post-LT is multifactorial, with pre-LT risk factors involved, including higher Model for End-stage Liver Disease score, more sever ESLD and pre-existing renal dysfunction, either with intra-operative conditions, in particular ischaemia reperfusion injury responsible for post-reperfusion syndrome (PRS) that can influence recipient’s morbidity and mortality. Post-reperfusion syndrome-induced AKI is an important complication post-LT that characterizes kidney involvement caused by PRS with mechanisms not clearly understood and implication on graft and patient survival. Since pre-LT risk factors may influence intra-operative events responsible for PRS-induced AKI, we aim to consider all the relevant aspects involved in PRS-induced AKI in the setting of LT and to identify all studies that better clarified the specific mechanisms linking PRS and AKI. A PubMed search was conducted using the terms liver transplantation AND acute kidney injury; liver transplantation AND post-reperfusion syndrome; acute kidney injury AND post-reperfusion syndrome; acute kidney injury AND DCD AND liver transplantation. Five hundred seventy four articles were retrieved on PubMed search. Results were limited to title/abstract of English-language articles published between 2000 and 2015. Twenty-three studies were identified that specifically evaluated incidence, risk factors and outcome for patients developing PRS-induced AKI in liver transplantation. In order to identify intra-operative risk factors/mechanisms specifically involved in PRS-induced AKI, avoiding confounding factors, we have limited our study to “acute kidney injury AND DCD AND liver transplantation”. Accordingly, three out of five studies were selected for our purpose.

Keywords: Liver transplantation; Acute kidney injury; Post-reperfusion syndrome; Donation after circulatory death; Chronic kidney disease

Core tip: Post-reperfusion syndrome (PRS)-induced acute kidney injury (AKI) has been recognized as an important complication occurring after liver transplantation (LT) that characterizes kidney involvement caused by PRS with mechanisms not clearly understood and implication on graft and patient survival. Since pre-LT risk factors may influence intra-operative events responsible for post-reperfusion syndrome-induced AKI (PRS-induced AKI), we aim to consider all the relevant aspects involved in PRS-induced AKI in the setting of LT and to identify all studies that better clarified the specific mechanisms linking PRS and AKI, in particular in LT recipients from donation after circulatory death.