Acute Kidney Injury Following Pediatric Liver Transplant

Silver, Layne; Pan, Stephanie; Bucuvalas, John C.; Reid-Adam, Jessica; Oishi, Kimihiko; Ofori-Amanfo, George; Gangadharan, Sandeep

doi:10.1177/0885066620978729

Cited by 8 publications

(10 citation statements)

References 28 publications

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“…Although we performed intraoperative measurements of hourly UO in the pediatric recipients in our study, no statistically significant differences were found between them and post-LT AKI 9 . Arani et 17 pointed out that the level of sCr plays the most critical role in the occurrence of mild/moderate and severe AKI, which is consistent with the existing literature 11,24,25 . Haan et al 11 noted that impairment of preoperative renal function, either as CKD or AKI, could be a risk factor for post-LT AKI (26).…”

Section: Discussionsupporting

confidence: 81%

Acute Kidney Injury After Liver Transplantation: Incidence, Risk Factors, and Outcomes

Ersoy

Çekmen

Özdemirkan

et al. 2023

JoCASS

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Introduction: Although numerous risk factors for acute kidney injury (AKI) have been identified, their cumulative impact remains unclear. This study aimed to identify perioperative risk factors for early post-transplant AKI on patients and outcomes and to predict AKI using clinical variables. Material and Methods: A single-center, retrospective cohort study involving 34 pediatric patients and 31 adults who underwent LT between 2015 and 2017. Results: AKI occurred in 16 (47%) pediatric patients during the first-week post-LT with stage 1, stage 2, and stage 3 AKI frequencies of 43.8, 50, and 6.3%, respectively. Renal replacement therapy (RRT) was initiated in 18.8% of pediatric LT patients. Preoperative liver enzymes and the etiology of liver failure are the most critical factors affecting AKI in pediatric LT patients. AKI occurred in 15 (48%) adult patients during the first-week post-LT with stage 1, stage 2, and stage 3 AKI frequencies of 43%, 21%, and 21%, respectively. The requirement for RRT was seen in 43% of adult LT patients. There were also statistical differences between the two groups regarding the number of patients with preoperative kidney dysfunction (20-80%, p=.047) and mortality rates (6-31 %, p=.047). In adult patients who developed post-LT AKI compared with those who did not develop post-LT AKI, they had significantly higher levels of serum creatinine (sCr) (1.9±1.9 mg/dL vs. 0.7±0.1 mg/dL, p=.013), were given lower amounts of crystalloids (73±32 mL/kg vs. 106±33 mL/kg, p=.018) and had lower urine output (UO) intraoperatively (11±9 mL/kg vs. 20±9 mL/kg, p=.047). There was a higher mortality rate in adult patients with post-LT AKI (89 vs. 11%, p=.003). Conclusion: The results of our study contribute to raising awareness of the potential risk factors associated with preoperative evaluation, intraoperative and postoperative close follow-up, careful anesthesia management, and early onset of post-LT AKI.

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Section: Discussionsupporting

confidence: 81%

Acute Kidney Injury After Liver Transplantation: Incidence, Risk Factors, and Outcomes

Ersoy

Çekmen

Özdemirkan

et al. 2023

JoCASS

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“…For example, our center employs strategies such as noninvasive monitoring of the fluid status, close monitoring of the tacrolimus levels, and critical inspection of drug administration by the clinical pharmacist in the PICU. In previous studies, factors associated with post-LT AKI in children included a history of AKI prior to transplantation [ 19 ], an elevated post-LT total bilirubin level, blood loss during surgery [ 20 ], a lower preoperative serum albumin level [ 23 ], and a prolonged international normalized ratio [ 21 ]. The authors postulated that the severity of preoperative synthetic liver function may be associated with the development of postoperative AKI [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…In previous studies, factors associated with post-LT AKI in children included a history of AKI prior to transplantation [ 19 ], an elevated post-LT total bilirubin level, blood loss during surgery [ 20 ], a lower preoperative serum albumin level [ 23 ], and a prolonged international normalized ratio [ 21 ]. The authors postulated that the severity of preoperative synthetic liver function may be associated with the development of postoperative AKI [ 21 ]. In this study, we found no association between AKI and the severity of liver disease as assessed by the PELD score.…”

Section: Discussionmentioning

confidence: 99%

Postoperative hypoalbuminemia and outcomes of pediatric liver transplantation

Uasuwannakul,

Lertudomphonwanit,

Anantasit

et al. 2024

BMC Pediatr

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Background Hypoalbuminemia after liver transplantation (LT) is associated with acute kidney injury (AKI) and poor outcomes in adult LT recipients. This study was performed to examine the association between the postoperative serum albumin level and early postoperative outcomes of LT in children. Methods This single-center retrospective review involved pediatric LT recipients (0–18 years old) treated from January 2013 to June 2020. All patients were admitted to PICU and received standard post-LT care protocol. We divided patients into low (< 30 g/L) and normal (> 30 g/L) groups based on postoperative albumin day 1 to 3. Results Among 108 LT recipients, most had biliary atresia. The median age at the time of LT was 1.8 years [interquartile range (IQR), 1.5–5.7]. There were 18 patients in low albumin group [median albumin level, 27.9 g/L (IQR, 25.8–29.6) and 90 patients in normal albumin group [median albumin level, 34.5 g/L (IQR, 32.4–36.9). The low albumin group had significantly higher incidence of AKI, occurring in 20% of patients with a median onset of 2.5 days following LT (IQR, 1–5). Postoperative hypoalbuminemia (OR, 4.94; 95% CI, 1.32–18.47; p = 0.01) and a longer operative time (OR, 1.37; 95% CI, 1.01–1.47; p = 0.02) were independent risk factors for AKI by multivariable analysis. No significant differences between the two groups were found in other early postoperative outcomes. Conclusion Postoperative hypoalbuminemia was associated with early postoperative AKI following LT in children but not with other worsening outcomes.

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“…A previous study by Ferah et al [ 26 ] showed that the development of AKI was correlated with higher serum sodium and lower plasma albumin levels. In the post-liver transplant setting, the development of AKI represents a surrogate marker for the worst clinical course [ 24 , 26 ], what makes it important to detect potential early biomarkers for this evolution. Due to the retrospective nature of the study, however, it is possible only to establish correlations but not causality.…”

Section: Discussionmentioning

confidence: 99%

Effects of serum sodium and chloride levels in the outcome of critically ill pediatric patients in the post-operative period of liver transplantation

et al. 2023

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Background Sodium and chloride disturbances have attracted increasing attention in recent years. Many pathophysiological effects are associated with hyperchloremia, including reduction in mean arterial pressure and acute renal disease. Pediatric patients undergoing liver transplantation are at risk of developing various electrolyte and biochemical abnormalities, with an impact on their postoperative outcomes. Objective To analyze the impacts of serum sodium and chloride levels on prognosis of Pediatric Liver Transplant receptors. Methods This was a retrospective analytical observational study performed in a single transplant reference center in Sao Paulo, Brazil. Included patients were pediatric patients who underwent liver transplantation between January 2015 and July 2019. Statistical regression analysis and General Estimating Equations analysis were performed to evaluate the impacts of sodium and chloride disturbances on the development of acute renal failure and mortality. Results A total of 143 patients were included in this study. The main diagnosis was Biliary Atresia (62.9%). Twenty-seven patients died (18.9%), and graft dysfunction was the main cause of death (29.6%). The only variable individually associated with 28-days mortality was PIM-3 score (HR 1.59, CI 95% 1.165–2.177, p = 0.004). Forty-one patients (28.6%) developed moderate or severe AKI. PIM-3 score (OR 3.052, 95% CI 1.56–5.97, p = 0.001), hypernatremia (OR 3.49, 95% CI 1.32–9.23, p = 0.012), and hyponatremia (OR 4.24, 95% CI 1.52–11.85, p = 0.006) were independently associated with the development of moderate/severe AKI. Conclusions In pediatric patients after liver transplantation, PIM-3 score, and abnormal serum sodium levels were correlated with AKI development.

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Acute Kidney Injury Following Pediatric Liver Transplant

Cited by 8 publications

References 28 publications

Acute Kidney Injury After Liver Transplantation: Incidence, Risk Factors, and Outcomes

Acute Kidney Injury After Liver Transplantation: Incidence, Risk Factors, and Outcomes

Postoperative hypoalbuminemia and outcomes of pediatric liver transplantation

Effects of serum sodium and chloride levels in the outcome of critically ill pediatric patients in the post-operative period of liver transplantation

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