Intraoperative systemic biomarkers predict post-liver transplantation acute kidney injury

Abstract

Objective Liver transplant (LT) is a definitive therapeutic option for patients with chronic liver disease. However, acute kidney injury after LT (post-LT AKI) is a frequent complication that may lead to graft dysfunction and decrease life expectancy. Delay in AKI detection by traditional biomarkers boosted research with new biomarkers for post-LT AKI as neutrophil gelatinase-associated lipocalin (NGAL) and syndecan-1. We aim to evaluate associations of intraoperative systemic NGAL and syndecan-1 levels with post-LT AKI. Methods This is a prospective study conducted in 46 patients selected for LT. Patients were evaluated preoperatively and blood samples were collected intraoperatively: T1 (after induction of anesthesia), T2 (anhepatic phase) and T3 (2 h after reperfusion of the graft). Results The mean age was 54 ± 12 years and 60% were male. Post-LT AKI was observed in 24 (52%) patients of which 12% needed dialysis. Serum NGAL and syndecan-1 increased along surgical phases. Mostly, increment values of serum NGAL of T2 to T3 and syndecan-1 at T3 were importantly associated with post-LT AKI. Into a multivariate model with model for end-stage liver disease score, age, gender, warm ischemia, cold ischemia and surgery time, syndecan-1 levels at T3 remains capable to predict post-LT AKI. Serum NGAL had significance only with increment values calculated by the ratio of ‘T3/T2’. Finally, serum syndecan-1 at T3 had a better diagnostic performance in receiver operating characteristic curve analysis. Conclusion Serum syndecan-1 levels in 2 h after reperfusion were most useful in early post-LT AKI diagnosis and may be used to construct new risk groups in this context.

A Sarcopenia-Based Prediction Model for Postoperative Complications of ex vivo Liver Resection and Autotransplantation to Treat End-Stage Hepatic Alveolar Echinococcosis

“…As expected, the surgical time of ELRA was selected as an independent risk factor for major postoperative complications. In 2020, Giustiniano et al 69 and Cezar et al 70 found that surgical time was associated with postoperative complications of liver resection and could predict acute kidney injury after liver transplantation, which is similar to our results. Therefore, we should strictly comply with aseptic principles and further improve our surgical efficiency to minimize postoperative complications.…”

Predictive utility of postoperative serum myoglobin in acute kidney injury after liver transplantation

“…There have been shown that renal hypo-perfusion, surgery time and hemodynamic instability at intraoperative, systemic inflammatory response, along with the choice of antibiotics which have nephrotoxicity in the post-transplant period, were common aetiological factors (25,33,35,36). Risk factors for AKI in the pre-transplant period include syndecan-1 level, the level of serum NGAL, high vitamin B12, recipient age and C-reactive protein (CRP) (19,24,37,38). Although these clinical variables have provided predictive values in identifying the occurrence of AKI after LT, the additional use of specific serum biomarkers might further improve the ability to identify patients with AKI.…”

“…According to the previous study, the data associated with postoperative AKI after LT were collected (5,20,24,25). Baseline characteristics of patients were obtained including age, sex, body mass index (BMI), model for end-stage liver disease (MELD) score, Child-Pugh classification, aetiology for LT (tumor, viral disease, alcoholic or others), and history of hypertension, diabetes mellitus, coronary disease or infection, as well as use of diuretics and nephrotoxic drug including vancomycin, aminoglycosides, rifampicin, amphotericin B, immunosuppressants and chemotherapy, etc.…”

Role of Novel Kidney Biomarkers in Patients With Cirrhosis and After Liver Transplantation

“…In general, NGAL measured within 2‐6 hours after reperfusion predicts post‐LT AKI, ( 77,81,82 ) although not in living donor LT. ( 76 ) Several studies report that change in, rather than absolute value of, NGAL was useful in predicting post‐LT AKI. ( 74,77,80,81,83,84 ) Among patients with AKI, uNGAL levels did not predict which patients will require renal replacement therapy. ( 85 )…”

“…(73) Intraoperative and perioperative NGAL measurements show acceptable performance in predicting AKI (AUC > 0.7) in most studies. (74)(75)(76) NGAL may predict AKI after LT earlier than other biomarkers. (73) In 1 study, it peaked 19-28 hours (urine) and 12-23 hours (plasma) earlier than sCr.…”