Effects of acute kidney injury after liver resection on long-term outcomes

Abstract

BackgroundTo investigate the effects of acute kidney injury (AKI) after liver resection on the long-term outcome, including mortality and renal dysfunction after hospital discharge.MethodsWe conducted a historical cohort study of patients who underwent liver resection for hepatocellular carcinoma with sevoflurane anesthesia between January 2004 and October 2011, survived the hospital stay, and were followed for at least 3 years or died within 3 years after hospital discharge. AKI was diagnosed based on the Acute Kidney Injury Network classification within 72 hours postoperatively. In addition to the data obtained during hospitalization, serum creatinine concentration data were collected and the glomerular filtration rate (GFR) was estimated after hospital discharge.ResultsAKI patients (63%, P = 0.002) were more likely to reach the threshold of an estimated GFR (eGFR) of 45 ml/min/1.73 m2 within 3 years than non-AKI patients (31%) although there was no significant difference in mortality (33% vs. 29%). Cox proportional hazard regression analysis showed that postoperative AKI was significantly associated with the composite outcome of mortality or an eGFR of 45 ml/min/1.73 m2 (95% CI of hazard ratio, 1.05–2.96, P = 0.033), but not with mortality (P = 0.699), the composite outcome of mortality or an eGFR of 60 ml/min/1.73 m2 (P =0.347).ConclusionsAfter liver resection, AKI patients may be at higher risk of mortality or moderate renal dysfunction within 3 years. These findings suggest that even after discharge from the hospital, patients who suffered AKI after liver resection may need to be followed-up regarding renal function in the long term.

Severe acute kidney injury following major liver resection without portal clamping: incidence, risk factors, and impact on short-term outcomes

“…The strong correlation between the development of severe AKI and 90-day mortality (33%) underlines the clinical importance of the early identification of high-risk patients. Furthermore, the association between postoperative AKI and long-term adverse renal outcomes including chronic kidney disease, 38,39 or longterm mortality, 37 has been demonstrated in previous studies. With an area under the curve of 0.762, the predictive value of hepatectomy duration is as accurate as other more complex models.…”

Acute kidney injury after liver resection in elderly patients

“…However, if AKI does develop, these patients have significantly worse 30-day postoperative survival when compared to younger patients. Korean authors indicated in their retrospective analysis with 228 patients and AKI incidence after partial liver resection 11.8% that patients with AKI after liver resection may be at higher risk of mortality or moderate renal dysfunction within 3 years [18].…”

Acute kidney injury after hepatectomy can be reasonably predicted after surgery

“…Prior studies evaluating the risk of AKI after hepatectomy procedures are mainly studies conducted at a single institution . A major strength of our study is the use of a well‐established, national surgical dataset with data from over 100 institutions, allowing for greater generalizability, though the ACS‐NSQIP tends to reflect mainly larger, academic medical centers.…”