Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Mar 24, 2016; 6(1): 220-232
Published online Mar 24, 2016. doi: 10.5500/wjt.v6.i1.220
Incidence and risk factors for early renal dysfunction after liver transplantation
Patricia Wiesen, Paul B Massion, Jean Joris, Olivier Detry, Pierre Damas
Patricia Wiesen, Paul B Massion, Pierre Damas, Department of General Intensive Care, University Hospital of Liege, B-4000 Liege, Belgium
Jean Joris, Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Liege, B-4000 Liege, Belgium
Olivier Detry, Department of Abdominal Surgery and Transplantation, CHU Liege, University of Liege (CHU ULg), B-4000 Liege, Belgium
Author contributions: Wiesen P performed the literature review and wrote the manuscript; Massion PB and Damas P participated in article conception; Joris J and Detry O constituted part of the team involved in the care of liver transplanted patients.
Institutional review board statement: The study was reviewed and approved by the University Hospital of Liege Institutional Review Board.
Informed consent statement: We did not initially claim an informed consent from the patients. Indeed, according to the institutional ethics committee’s opinion, no informed consent was required in the frame of this retrospective study. However, we phoned all alive patients with available coordinates and obtained their oral informed consent.
Conflict-of-interest statement: The authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) in the subject matter or materials discussed in this manuscript. This statement is signed by all the authors to indicate agreement that the above information is true and correct.
Data sharing statement: No additional data are available.
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: Dr. Patricia Wiesen, Department of General Intensive Care, University Hospital of Liege, Domaine universitaire du Sart Tilman B35, B-4000 Liege, Belgium. p.wiesen@chu.ulg.ac.be
Telephone: +32-4-3667495 Fax: +32-4-3668898
Received: August 12, 2015
Peer-review started: August 13, 2015
First decision: September 28, 2015
Revised: November 27, 2015
Accepted: December 17, 2015
Article in press: December 18, 2015
Published online: March 24, 2016
Processing time: 219 Days and 14.3 Hours
Abstract

AIM: To determine renal dysfunction post liver transplantation, its incidence and risk factors in patients from a Belgian University Hospital.

METHODS: Orthotopic liver transplantations performed from January 2006 until September 2012 were retrospectively reviewed (n = 187). Patients with no renal replacement therapy (RRT) before transplantation were classified into four groups according to their highest creatinine plasma level during the first postoperative week. The first group had a peak creatinine level below 12 mg/L, the second group between 12 and 20 mg/L, the third group between 20 and 35 mg/L, and the fourth above 35 mg/L. In addition, patients who needed RRT during the first week after transplantation were also classified into the fourth group. Perioperative parameters were recorded as risk factors, namely age, sex, body mass index (BMI), length of preoperative hospital stay, prior bacterial infection within one month, preoperative ascites, preoperative treatment with β-blocker, angiotensin-converting enzyme inhibitor or non steroidal anti-inflammatory drugs, preoperative creatinine and bilirubin levels, donor status (cardiac death or brain death), postoperative lactate level, need for intraoperative vasopressive drugs, surgical revision, mechanical ventilation for more than 24 h, postoperative bilirubin and transaminase peak levels, postoperative hemoglobin level, amount of perioperative blood transfusions and type of immunosuppression. Univariate and multivariate analysis were performed using logistic ordinal regression method. Post hoc analysis of the hemostatic agent used was also done.

RESULTS: There were 78 patients in group 1 (41.7%), 46 in group 2 (24.6%), 38 in group 3 (20.3%) and 25 in group 4 (13.4%). Twenty patients required RRT: 13 (7%) during the first week after transplantation. Using univariate analysis, the severity of renal dysfunction was correlated with presence of ascites and prior bacterial infection, preoperative bilirubin, urea and creatinine level, need for surgical revision, use of vasopressor, postoperative mechanical ventilation, postoperative bilirubin and urea, aspartate aminotransferase (ASAT), and hemoglobin levels and the need for transfusion. The multivariate analysis showed that BMI (OR = 1.1, P = 0.004), preoperative creatinine level (OR = 11.1, P < 0.0001), use of vasopressor (OR = 3.31, P = 0.0002), maximal postoperative bilirubin level (OR = 1.44, P = 0.044) and minimal postoperative hemoglobin level (OR = 0.059, P = 0.0005) were independent predictors of early post-liver transplantation renal dysfunction. Neither donor status nor ASAT levels had significant impact on early postoperative renal dysfunction in multivariate analysis. Absence of renal dysfunction (group 1) was also predicted by the intraoperative hemostatic agent used, independently of the extent of bleeding and of the preoperative creatinine level.

CONCLUSION: More than half of receivers experienced some degree of early renal dysfunction after liver transplantation. Main predictors were preoperative renal dysfunction, postoperative anemia and vasopressor requirement.

Keywords: Liver transplantation, Acute kidney injury incidence, Perioperative complications, Acute kidney injury risk factors, Creatinine/blood, Severity renal failure

Core tip: One hundred and eighty-seven liver transplantations performed between 2006 and 2012 were retrospectively analyzed. Patients were classified into four groups according to their highest creatinine plasma level during the first postoperative week relying on sequential organ failure assessment renal classification. Perioperative parameters were recorded as risk factors. Univariate and multivariate analysis were performed. Fifty-eight percent of recipients experienced some degree of early postoperative renal dysfunction. The multivariate analysis showed that body mass index, preoperative creatinine level, use of vasopressor, hemostatic drug, postoperative bilirubin peak level and postoperative hemoglobin minimum level but not the donor status (cardiac dead or brain dead donor) were independent predictors of post-transplantation early renal dysfunction.