Acute Renal Disease, as Defined by the RIFLE Criteria, Post-Liver Transplantation

Abstract

Acute renal failure (ARF) can complicate up to 60% of orthotopic liver transplants (OLT). The RIFLE criteria were developed to provide a consensus definition for acute renal disease in critically ill patients. Using the RI-FLE criteria, we aimed to determine the incidence and risk factors for ARF and acute renal injury (ARI), and to evaluate the link with the outcomes, patient survival and length of hospital stay. Three hundred patients, who received 359 OLTs, were retrospectively analyzed. ARI and ARF occurred post 11.1 and 25.7% of OLTs, respectively. By multivariate analysis, ARI was associated with pre-OLT hypertension and alcoholic liver disease and ARF with higher pre-OLT creatinine, inotrope and aminoglycoside use. ARF, but not ARI, had an impact on 30-day and 1-year patient survival and longer length of hospital stay. ARI and ARF, as defined by the RIFLE criteria, are common complications of OLT, with distinct risk factors and ARF has serious clinical consequences. The development of a consensus definition is a welcome advance, however these criteria do need to be validated in large studies in a wide variety of patient populations.

Hypothermic Machine Preservation Facilitates Successful Transplantation of “Orphan” Extended Criteria Donor Livers

“…AKI is another common cause of morbidity after liver transplantation (30)(31)(32). It is directly related to hepatic ischemia reperfusion injury and has been shown to increase in DCD donors (33) as well as in donation after brain death donors (34).…”

The incidence and prognostic significance of acute kidney injury

“…Research has begun on the incidence and prognosis associated with the various stages of RIFLE [64][65][66][67][68][69][70]. One large study of 5383 intensive care unit admissions at a single center used an integrated database with physiologic and laboratory information to show that over two-thirds of all patients had some evidence of AKI during admission, and that over half of the patients with 'Risk' progressed; the hazard ratio for in-hospital mortality according to maximum RIFLE classification was not significant for 'Risk', of borderline statistical significance for 'Injury' (HR 1.4; 95% CI 1.0-1.9) and significant for 'Failure' (HR 2.7; 95% CI 2.0-3.6) [70].…”

Diagnosis, Epidemiology and Outcomes of Acute Kidney Injury

“…Research has begun on the incidence and prognosis associated with the various stages of RIFLE (47)(48)(49)(50)(51)(52)(53). One large study of 5383 ICU admissions at a single center used an integrated database with physiologic and laboratory information to show that more than twothirds of all patients had some evidence of AKI during admission and that more than one-half of patients with "Risk" progressed; the hazard ratio for in-hospital mortality according to maximum RIFLE classification was NS for "Risk," of borderline statistical significance for "Injury" (1.40; 95% CI, 1.02 to 1.88) and significant for "Failure" (HR ϭ 2.7; 95% CI, 2.03 to 3.55) (53).…”