Acute kidney injury after pediatric liver transplantation: incidence, risk factors, and association with outcome

Hamada, Miho; Matsukawa, Shino; Shimizu, Satoshi; Kai, Shinichi; Mizota, Toshiyuki

doi:10.1007/s00540-017-2395-2

Cited by 32 publications

(41 citation statements)

References 27 publications

(49 reference statements)

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“…1 Likewise, AKI after pediatric LTx is common with investigators reporting incidence rates ranging from 28% to 57% based on differing criteria used to define AKI. [2][3][4] Consistent with what is shown in other patient groups, AKI after pediatric LTx is associated with a significantly longer duration of mechanical ventilation, an increased hospital length of stay, and an increased risk of mortality. 3,4 Furthermore, AKI is a well-known risk factor for the development of chronic kidney damage and longitudinal studies have demonstrated the presence of renal insufficiency in a substantial proportion of the LTx population, including children.…”

Section: Introductionsupporting

confidence: 77%

The use of urinary biomarkers to predict acute kidney injury in children after liver transplant

Fuhrman

Kellum²,

Joyce

et al. 2019

Pediatric Transplantation

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Background: AKI after pediatric liver transplantation is associated with increased morbidity and mortality. The role of urinary biomarkers for the prediction of AKI in pediatric patients after liver transplantation has not been previously reported. The primary objective of this prospective pilot study was to determine the predictive capabilities of urinary KIM-1, NGAL, TIMP-2, and IGFBP7 for diagnosing AKI. Methods: Sixteen children undergoing liver transplantation were enrolled in the study over a 19month time period. The Kidney Disease Improving Outcomes criteria for urine output and serum creatinine were used to define AKI. Predictive ability was evaluated using the area under the curve obtained by ROC analysis.

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Section: Introductionsupporting

confidence: 77%

The use of urinary biomarkers to predict acute kidney injury in children after liver transplant

Fuhrman

Kellum²,

Joyce

et al. 2019

Pediatric Transplantation

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“…AKI is a common and significant complication after liver transplantation (LTx), and is associated with increased mortality, hospital length of stay, utilization of resources, and health care costs [9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27]. Although the survival of LTx recipients has improved substantially over the past five decades, mortality rates related to post-LTx AKI and subsequent progressive CKD remain high and are of increasing concern [14,15,28,29,30,31]. The underlying mechanisms for post-LTx AKI appear to be complex and differ from other medical or surgery-associated AKI [11,23,24,25,32,33,34,35].…”

Section: Introductionmentioning

confidence: 99%

“…Recent studies have suggested several important factors that influence post-LTx AKI, including hepatic ischemia-reperfusion injury (HIRI) [36,37,38], increased use of high-risk or marginal grafts, and transplantation of liver grafts to sicker patients with higher Model For End-Stage Liver Disease (MELD) score or with more comorbidities [23,39,40,41,42,43,44,45,46,47,48,49,50,51]. In our literature review, the reported incidences are a farrago, having a range between 5% to 94% [10,11,14,15,16,17,18,19,20,21,22,23,24,25,28,29,30,31,32,33,34,35,39,40,41,42,43,44,45,46,47,48,49,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,…”

Section: Introductionmentioning

confidence: 99%

“…In our literature review, the reported incidences are a farrago, having a range between 5% to 94% [10,11,14,15,16,17,18,19,20,21,22,23,24,25,28,29,30,31,32,33,34,35,39,40,41,42,43,44,45,46,47,48,49,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80]. These wide variabilities are possibly due to non-uniform definitions of AKI [10,11,14,15,16,17,18,19,20,21,22,2...…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Incidence and Impact of Acute Kidney Injury after Liver Transplantation: A Meta-Analysis

Thongprayoon

Kaewput

Thamcharoen

et al. 2019

JCM

101

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Background: The study’s aim was to summarize the incidence and impacts of post-liver transplant (LTx) acute kidney injury (AKI) on outcomes after LTx. Methods: A literature search was performed using the MEDLINE, EMBASE and Cochrane Databases from inception until December 2018 to identify studies assessing the incidence of AKI (using a standard AKI definition) in adult patients undergoing LTx. Effect estimates from the individual studies were derived and consolidated utilizing random-effect, the generic inverse variance approach of DerSimonian and Laird. The protocol for this systematic review is registered with PROSPERO (no. CRD42018100664). Results: Thirty-eight cohort studies, with a total of 13,422 LTx patients, were enrolled. Overall, the pooled estimated incidence rates of post-LTx AKI and severe AKI requiring renal replacement therapy (RRT) were 40.7% (95% CI: 35.4%–46.2%) and 7.7% (95% CI: 5.1%–11.4%), respectively. Meta-regression showed that the year of study did not significantly affect the incidence of post-LTx AKI (p = 0.81). The pooled estimated in-hospital or 30-day mortality, and 1-year mortality rates of patients with post-LTx AKI were 16.5% (95% CI: 10.8%–24.3%) and 31.1% (95% CI: 22.4%–41.5%), respectively. Post-LTx AKI and severe AKI requiring RRT were associated with significantly higher mortality with pooled ORs of 2.96 (95% CI: 2.32–3.77) and 8.15 (95%CI: 4.52–14.69), respectively. Compared to those without post-LTx AKI, recipients with post-LTx AKI had significantly increased risk of liver graft failure and chronic kidney disease with pooled ORs of 3.76 (95% CI: 1.56–9.03) and 2.35 (95% CI: 1.53–3.61), respectively. Conclusion: The overall estimated incidence rates of post-LTx AKI and severe AKI requiring RRT are 40.8% and 7.0%, respectively. There are significant associations of post-LTx AKI with increased mortality and graft failure after transplantation. Furthermore, the incidence of post-LTx AKI has remained stable over the ten years of the study.

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“…38,39 Wide and different ranges of AKI prevalence were reported in several studies, ranging from 17% and 50%, with small patients cohorts, often included in retrospective studies and using different methods to evaluate GFR. [40][41][42] Seventy-seven children, who underwent LTx, were enrolled to evaluate AKI prevalence, comparing the three standardized definitions of AKI based on serum creatinine values, Pediatric RIFLE (pRI-FLE), AKIN, and KDIGO criteria. In particular, pRIFLE detected AKI in 57% of patients, whereas AKIN and KDIGO criteria in only 43% of them.…”

Section: Acute K Idne Y Inj Ury Af Ter Ped Iatri C Lt Xmentioning

confidence: 99%

Acute and chronic kidney disease after pediatric liver transplantation: An underestimated problem

Lacquaniti

Campo

Tocco

et al. 2020

Clinical Transplantation

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Acute and chronic kidney injuries represent critical issues after liver transplantation (LTx), but whereas renal dysfunction in adult transplant patients is well documented, little is known about its prevalence in childhood. It is a challenge to accurately evaluate renal function in patients with liver disease, due to several confounding factors. Creatinine-based equations estimating glomerular filtration rate, validated in nephropathic patients without hepatic issues, are frequently inaccurate in end-stage liver disease, underestimating the real impact of renal disease. Moreover, whereas renal issues observed within 1 year from LTx were often related to acute injuries, kidney damage observed after 5-7 years from LTx, is due to chronic, irreversible mechanisms. Most immunosuppression protocols are based on calcineurin inhibitors (CNIs) and corticosteroids, but mycophenolate mofetil or sirolimus could play significant roles, also in children. Early diagnosis and personalized treatment represent the bases of kidney disease management, in order to minimize its close relation with increased mortality. This review analyzed acute and chronic kidney damage after pediatric LTx, also discussing the impact of pre-existent renal disease. The main immunosuppressant strategies have been reviewed, highlighting their impact on kidney function. Different methods assessing renal function were reported, with the potential application of new renal biomarkers.

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Acute kidney injury after pediatric liver transplantation: incidence, risk factors, and association with outcome

Abstract: The incidence of AKI after pediatric liver transplantation was 46.2%. Increased preoperative total bilirubin level and increased intraoperative blood loss were independently associated with the development of AKI. AKI was associated with prolonged hospitalization.

Cited by 32 publications

References 27 publications

The use of urinary biomarkers to predict acute kidney injury in children after liver transplant

The use of urinary biomarkers to predict acute kidney injury in children after liver transplant

Incidence and Impact of Acute Kidney Injury after Liver Transplantation: A Meta-Analysis

Acute and chronic kidney disease after pediatric liver transplantation: An underestimated problem

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