Early Acute Kidney Injury Associated with Liver Transplantation: A Retrospective Case-Control Study

Guo, Mengzhuo; Gao, Yuanchao; Wang, Linlin; Zhang, Haijing; Lu, Xian; Zhang, Huan

doi:10.12659/msm.923864

Cited by 11 publications

(6 citation statements)

References 29 publications

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“…The requirement for FFP during OLT was independently associated with post-OLT AKI, which was consistent with previous studies [ 28 , 43 ]. The reason for this result may be that recipients often experience massive blood loss due to portal hypertension and coagulation dysfunction during OLT.…”

Section: Discussionsupporting

confidence: 92%

Development and validation of a nomogram for predicting acute kidney injury after orthotopic liver transplantation

et al. 2021

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Background We aim to develop and validate a nomogram model for predicting severe acute kidney injury (AKI) after orthotopic liver transplantation (OLT). Methods A total of 576 patients who received OLT in our center were enrolled. They were assigned to the development and validation cohort according to the time of inclusion. Univariable and multivariable logistic regression using the forward variable selection routine were applied to find risk factors for post-OLT severe AKI. Based on the results of multivariable analysis, a nomogram was developed and validated. Patients were followed up to assess the long-term mortality and development of chronic kidney disease (CKD). Results Overall, 35.9% of patients were diagnosed with severe AKI. Multivariable logistic regression analysis revealed that recipients’ BMI (OR 1.10, 95% CI 1.04–1.17, p = 0.012), hypertension (OR 2.32, 95% CI 1.22–4.45, p = 0.010), preoperative serum creatine (sCr) (OR 0.96, 95% CI 0.95–0.97, p < 0.001), and intraoperative fresh frozen plasm (FFP) transfusion (OR for each 1000 ml increase 1.34, 95% CI 1.03–1.75, p = 0.031) were independent risk factors for post-OLT severe AKI. They were all incorporated into the nomogram. The area under the ROC curve (AUC) was 0.73 ( p < 0.05) and 0.81 ( p < 0.05) in the development and validation cohort. The calibration curve demonstrated the predicted probabilities of severe AKI agreed with the observed probabilities ( p > 0.05). Kaplan-Meier survival analysis showed that patients in the high-risk group stratified by the nomogram suffered significantly poorer long-term survival than the low-risk group (HR 1.92, p < 0.01). The cumulative risk of CKD was higher in the severe AKI group than no severe AKI group after competitive risk analysis (HR 1.48, p < 0.05). Conclusions With excellent predictive abilities, the nomogram may be a simple and reliable tool to identify patients at high risk for severe AKI and poor long-term prognosis after OLT.

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Section: Discussionsupporting

confidence: 92%

Development and validation of a nomogram for predicting acute kidney injury after orthotopic liver transplantation

et al. 2021

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“…Our study found that sirolimus and MMF did not significantly differ in their impact on the risk of developing AKD after LT. AKI or AKD is a crucial prognostic risk factor following LT, and its occurrence may be linked to increased mortality [ 8 , 11 , 12 ], extended hospital stay, higher hospitalization expenses [ 9 ], graft failure [ 10 ], and persistent renal dysfunction post-LT [ 8 ]. Moreover, the current discussions on AKD are relatively limited.…”

Section: Discussionmentioning

confidence: 99%

“…CKD is defined as an abnormality of kidney structure or function for more than 3 months [ 7 ]. The development of post-LT AKI is associated with an increased risk of CKD [ 8 ], prolonged hospital stay [ 9 ], higher incidence of graft failure [ 10 ], and even higher mortality rates [ 8 , 11 , 12 ]. CKD is the final manifestation of persistent intrinsic renal damage, particularly after several AKI events.…”

Section: Introductionmentioning

confidence: 99%

Impact of Sirolimus versus Mycophenolate Mofetil on Kidney Function after Calcineurin Inhibitor Dose Reduction in Liver Transplant Recipients

Chiang,

Li,

Hsu

et al. 2023

Pharmaceuticals

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Impaired kidney function is associated with increased morbidity and mortality in patients undergoing liver transplantation. Although immunosuppressants are essential in these patients, they impair kidney function. This study aimed to compare adverse kidney outcomes between patients treated with a reduced dose of tacrolimus (calcineurin inhibitor) plus sirolimus or mycophenolate mofetil (MMF) in the liver transplant center at Kaohsiung Chang Gung Memorial Hospital between April 2011 and December 2017. Propensity score matching was used to identify 232 patients. The risk of adverse kidney outcomes was estimated using Cox proportional hazards regression, and changes in kidney function over time were analyzed using linear mixed modeling. Acute kidney disease risks in this study cohort were not significantly different for the two immunosuppressants (aHR 1.04; 95% CI: 0.70–1.55, p = 0.8328). However, sirolimus use was significantly associated with a higher risk of estimated glomerular filtration rate decline > 30% than MMF (aHR, 2.09; 95% CI: 1.33–3.28; p = 0.0014). Our results demonstrate that sirolimus use may have worsened long-term kidney outcomes compared to MMF. Close monitoring of kidney function, dose adjustment, and timely transition to MMF is necessary for LT patients receiving sirolimus.

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“…AKI is a common complication after OLT [ 34 ]. In this study, the incidence of AKI in the NOCKD group was 75.9%, significantly higher than that in the non-AKI group (22.1%).…”

Section: Discussionmentioning

confidence: 99%

Risk Factors and Prognosis of New-Onset Chronic Kidney Disease Following Orthotopic Liver Transplantation: A Retrospective Case-Control Study

Duan

Wang

et al. 2021

Med Sci Monit

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Background We have undertaken this investigation to explore the perioperative risk factors of new-onset chronic kidney disease (NOCKD) after orthotopic liver transplantation (OLT), and to provide an early prediction model for the screening of NOCKD high-risk populations. Material/Methods A retrospective case-control study was performed in adult recipients who received OLT in our center between January 2018 and January 2020. Perioperative data were collected using the center’s electronic medical record system. Logistics regression analysis was used to determine risk factors for NOCKD within 1 year following OLT. Kaplan-Meier and log-rank tests were used to evaluate the 1-year survival of recipients with NOCKD or without NOCKD. Results A total of 174 patients were included in this study, and 29 patients developed NOCKD after OLT. Logistic multivariate regression analysis showed that preoperative diabetes, high model for end-stage liver disease (MELD) score, postoperative acute kidney injury (AKI), and postoperative renal replacement therapy (RRT) were independent risk factors for NOCKD 1 year after OLT. The 1-year survival rate of NOCKD recipients waas significantly lower than that of patients who did not receive NOCKD. Conclusions Diabetes mellitus, MELD score, postoperative AKI, and requirement for postoperative RRT are independent risk factors for NOCKD after OLT, which may have great potential for personalized decision making and predicting the 1-year postoperative mortality of the recipient.

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Early Acute Kidney Injury Associated with Liver Transplantation: A Retrospective Case-Control Study

Cited by 11 publications

References 29 publications

Development and validation of a nomogram for predicting acute kidney injury after orthotopic liver transplantation

Development and validation of a nomogram for predicting acute kidney injury after orthotopic liver transplantation

Impact of Sirolimus versus Mycophenolate Mofetil on Kidney Function after Calcineurin Inhibitor Dose Reduction in Liver Transplant Recipients

Risk Factors and Prognosis of New-Onset Chronic Kidney Disease Following Orthotopic Liver Transplantation: A Retrospective Case-Control Study

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