Early Acute Kidney Injury after Liver Transplantation: Predisposing Factors and Clinical Implications

Rahman, Suehana

doi:10.26226/morressier.58eb975cd462b80290b4fb4c

Cited by 9 publications

(18 citation statements)

References 26 publications

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“…First, the peak AST level within 24 hours was higher in this group of patients, even though it normalized within the early postoperative period. It has been previously reported that high AST levels after transplantation can correlate with worse patient and graft outcome . Second, there was a higher rate of blood loss in the DCD group.…”

Section: Discussionmentioning

confidence: 86%

Expanding the donor pool: Donation after circulatory death and living liver donation do not compromise the results of liver transplantation

et al. 2018

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Because of the shortfall between the number of patients listed for liver transplantation (LT) and the available grafts, strategies to expand the donor pool have been developed. Donation after circulatory death (DCD) and living donor (LD) grafts are not universally used because of the concerns of graft failure, biliary complications, and donor risks. In order to overcome the barriers for the implementation of using all 3 types of grafts, we compared outcomes after LT of DCD, LD, and donation after brain death (DBD) grafts. Patients who received a LD, DCD, or DBD liver graft at the University of Toronto were included. Between January 2009 through April 2017, 1054 patients received a LT at our center. Of these, 77 patients received a DCD graft (DCD group); 271 received a LD graft (LD group); and 706 received a DBD graft (DBD group). Overall biliary complications were higher in the LD group (11.8%) compared with the DCD group (5.2%) and the DBD group (4.8%; P < 0.001). The 1‐, 3‐, and 5‐year graft survival rates were similar between the groups with 88.3%, 83.2%, and 69.2% in the DCD group versus 92.6%, 85.4%, and 84.7% in the LD group versus 90.2%, 84.2%, and 79.9% in the DBD group (P = 0.24). Furthermore, the 1‐, 3‐, and 5‐year patient survival was comparable, with 92.2%, 85.4%, and 71.6% in the DCD group versus 95.2%, 88.8%, and 88.8% in the LD group versus 93.1%, 87.5%, and 83% in the DBD group (P = 0.14). Multivariate Cox regression analysis revealed that the type of graft did not impact graft survival. In conclusion, DCD, LD, and DBD grafts have similar longterm graft survival rates. Increasing the use of LD and DCD grafts may improve access to LT without affecting graft survival rates. Liver Transplantation 24 779–789 2018 AASLD.

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Section: Discussionmentioning

confidence: 86%

Expanding the donor pool: Donation after circulatory death and living liver donation do not compromise the results of liver transplantation

et al. 2018

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“…Non‐renal organ transplant surgery also carries a significant risk of postoperative AKI. In orthotopic liver transplantation, for example, AKI rates of 25–60% have been observed, and in a single‐centre study, AKI occurred in 50% of patients, and was associated with a reduction in 90‐day survival of nearly 9% . Intraperitoneal surgery in general, and particularly small bowel resection, is also associated with increased risk of postoperative AKI .…”

Section: Who Is At Risk Of Renal Complications?mentioning

confidence: 99%

Renal complications of anaesthesia

2018

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SummaryPeri-operative acute kidney injury is common, accounting for 30-40% of all in-hospital cases of acute kidney injury. It is associated with clinically significant morbidity and mortality even with what was hitherto regarded as relatively trivial increases in serum creatinine, and carries over a 12-fold relative risk of death following major abdominal surgery. Comorbid conditions such as diabetes, hypertension, liver disease and particularly pre-existing chronic kidney disease, as well as the type and urgency of surgery, are major risk factors for the development of postoperative acute kidney injury. As yet, there are no specific treatment options for the injured kidney, although there are several modifiable risk factors of which the anaesthetist should be aware. As well as the avoidance of potential nephrotoxins and appropriate volume balance, optimal anaesthetic management should aim to reduce the risk of postoperative renal complications. This may include careful ventilatory management and blood pressure control, as well as appropriate analgesic strategies. The choice of anaesthetic agent may also influence renal outcomes. Rather than concentrate on the classical management of acute kidney injury, this review focuses on the potential development of acute kidney injury peri-operatively, and the means by which this may be ameliorated.

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“…Один из главных этиологических факторов ОПП при ТП -ишемическое и реперфузионное повреждение трансплантата [11,13,33] Патогенез ОПП остается до конца неясным [11]. В патогенезе ОПП при ишемическом и реперфузионном повреждении трансплантированной печени I. Jochmans et al [13] выделяют четыре составляющие.…”

Section: этиология и патогенез острого повреждения почекunclassified

“…В то же время единственным достоверным предиктором ишемического и реперфузионного повреждения ТП является повышение уровня аспартатаминотрансферазы в плазме крови. Поэтому повышение уровня этого фермента в плазме крови следует рассматривать и как предиктор ОПП [13,33].…”

Section: диагностика острого повреждения почекunclassified

“…Развитие умеренного или тяжелого ишемического и реперфузионного повреждения трансплантированной печени совместно с ОПП оказывает наибольшее негативное влияние на результаты лечения этих пациентов. Выживание пациентов с двумя этими осложнениями в течение первых 90 дней после операции составляло 89%, а у пациентов без этих осложнений или только с одним из них -100% [33].…”

Section: исходы острого повреждения почекunclassified

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New trends in the study of post-transplant acute kidney injury after liver transplantation

Ильинский

Цирульникова

2020

RJTAO

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Acute kidney injury (AKI) after liver transplantation (LT) is a pressing issue and remains the focus of many researchers. The etiology of AKI is multifactorial, but the main one is ischemia-reperfusion injury to the liver transplant. Numerous preoperative, intraoperative and postoperative risk factors contribute to the development of AKI. The use of standard classifications, such as AKIN, RIFLE and KDIGO, has improved post-transplant AKI diagnosis. However, determination of creatinine levels in the blood enables AKI diagnosis only in the later stages of this syndrome. Therefore, studies are currently underway to find ways of early diagnosis of AKI using biomarkers. Transition to a molecular level not only improves accuracy but also facilitates early diagnosis of AKI. Currently, the diagnostic capabilities of neutrophil gelatinase-associated lipocalin (NGAL) are the most investigated. To date, there are no known measures of preventing post-transplant AKI. Moreover, treatment of this condition cannot be considered satisfactory. Even a mild post-transplant AKI can be fatal. In severe AKI, where renal replacement therapy is used, there is a risk of death in the intensive care unit. More than half of AKI patients develop chronic kidney disease requiring chronic hemodialysis.

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Early Acute Kidney Injury after Liver Transplantation: Predisposing Factors and Clinical Implications

Cited by 9 publications

References 26 publications

Expanding the donor pool: Donation after circulatory death and living liver donation do not compromise the results of liver transplantation

Expanding the donor pool: Donation after circulatory death and living liver donation do not compromise the results of liver transplantation

Renal complications of anaesthesia

New trends in the study of post-transplant acute kidney injury after liver transplantation

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