Risk factors for acute renal injury in living donor liver transplantation: evaluation of the RIFLE criteria

Abstract

Summary Acute renal injury (ARI) is a serious complication after liver transplantation. This study investigated the usefulness of the RIFLE criteria in living donor liver transplantation (LDLT) and the prognostic impact of ARI after LDLT. We analyzed 200 consecutive adult LDLT patients, categorized as risk (R), injury (I), or failure (F), according to the RIFLE criteria. ARI occurred in 60.5% of patients: R‐class, 23.5%; I‐class, 21%; and F‐class, 16%. Four patients in Group‐A (normal renal function and R‐class) and 26 patients in Group‐B (severe ARI: I‐ and F‐class) required renal replacement therapy (P < 0.001). Mild ARI did not affect postoperative prognosis regarding hospital mortality rate in Group A (3.2%), which was superior to that in Group B (15.8%; P = 0.0015). Fourteen patients in Group B developed chronic kidney disease (KDIGO stage 3/4). The 1‐, 5‐ and 10‐year survival rates were 96.7%, 90.6%, and 88.1% for Group A and 71.1%, 65.9%, and 59.3% for Group B, respectively (P < 0.0001). Multivariate analysis revealed risk factors for severe ARI as MELD ≥20 [odds ratio (OR) 2.9], small‐for‐size graft (GW/RBW <0.7%; OR 3.1), blood loss/body weight >55 ml/kg (OR 3.7), overexposure to calcineurin inhibitor (OR 2.5), and preoperative diabetes mellitus (OR 3.2). The RIFLE criteria offer a useful predictive tool after LDLT. Severe ARI, defined beyond class‐I, could have negative prognostic impact in the acute and late postoperative phases. Perioperative treatment strategies should be designed and balanced based on the risk factors for the further improvement of transplant prognosis.

Risk Analysis for Invasive Fungal Infection after Living Donor Liver Transplantation: Which Patient Needs Potent Prophylaxis?

“…Therefore, we used the RIFLE criteria to define AKI after LDLT. We reported previously that the RIFLE criteria offer a useful predictive tool after LDLT [22]. The risk factors for AKI identified in the present study included MELD score of ≥20, graft weight per recipient body weight ratio of <0.7%, blood loss/body weight ratio of >55 mL/kg, no use of MMF, and the presence of preoperative diabetes mellitus [22].…”

“…We reported previously that the RIFLE criteria offer a useful predictive tool after LDLT [22]. The risk factors for AKI identified in the present study included MELD score of ≥20, graft weight per recipient body weight ratio of <0.7%, blood loss/body weight ratio of >55 mL/kg, no use of MMF, and the presence of preoperative diabetes mellitus [22]. For a recipient with these risk factors to progress to severe AKI, a systematic operative plan and postoperative care should be considered, which include sufficient graft volume, use of MMF combined with reduced CNI, transfusion during the perioperative phase, and early introduction of renal replacement therapy to prevent severe AKI [22].…”

“…The RIFLE criteria classify AKI according to the degree of renal impairment, namely, the Risk of renal dysfunction (R), Injury to the kidney (I), Failure (F) or Loss (L) of kidney function, and End-stage kidney disease (E). In this study, we defined severe AKI as I- or F-class according to our previous report, which examined the predictive criteria of RIFLE after LDLT [22]. All patients received routine perioperative prophylactic antibiotics started immediately before surgery and continued 5 days.…”

“…The MELD score was calculated according to the formula: MELD score = 9.57 × Ln creatinine (mg/dL) + 11.2 × (Ln INR) + 3.78 × Ln bilirubin (mg/dL) + 6.43, where Ln stands for natural logarithm and INR for international normalized ratio for prothrombin time [20]. Postoperative acute kidney injury (AKI) was defined according to the RIFLE criteria developed by The Acute Dialysis Quality Initiative Working Group [21, 22]. The RIFLE criteria classify AKI according to the degree of renal impairment, namely, the Risk of renal dysfunction (R), Injury to the kidney (I), Failure (F) or Loss (L) of kidney function, and End-stage kidney disease (E).…”

Evaluation of Factors Influencing Renal Dysfunction Following Living Donor Liver Transplantation

“…Another study from Ireland by O'Riordan et al [29] found that 10 y cumulative incidence of renal dysfunction for stages 0/1, 2, 3, 4 and 5 of CKD as 9.61, 53.7, 56.77, 6.11 and 2.62%, respectively. The incidence of AKI was 60.5% at an average tacrolimus trough level of 10.3±0.51 (µg/l) in a study conducted by Utsumi et al [30] from Japan. The lower incidence of renal dysfunction in our study may be due to the relatively low trough levels (<7 µg/l) of tacrolimus maintained for our patients.…”