Risk factors of acute renal failure after liver transplantation

Cabezuelo, J B; Ramı́rez, Pablo; Rı́os, Antonio; Acosta, F; Torres, Diletta Domenica; Sansano, T; Pons, JA; Bru, Mariano; Montoya, M.J.; Bueno, F.S; Robles, R; Parrilla, Pascual

doi:10.1038/sj.ki.5000216

Cited by 273 publications

(223 citation statements)

References 32 publications

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“…Our results are consistent with prior studies conducted in specific subgroups, ICU patients and those undergoing cardiac surgery, in finding prior kidney function to be a main risk factor for HAKI. [11,12,[14][15][16][17][19][20][21][22][23][24][30][31][32] While prior studies have found low systolic blood pressure to be a risk factor for HAKI, we are the first to report elevated pulse as a risk factor. [6,33] Prior studies have reported that low pH and low bicarbonate levels are risk factors for HAKI.…”

Section: Discussionmentioning

confidence: 63%

Predicting Hospital-Acquired Acute Kidney Injury—A Case-Controlled Study

2008

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Acute kidney injury is a major complication of hospitalization, occurring in 5-7 percent of hospitalized patients. The patient characteristics and prognostic variables that help predict acute kidney injury have not been studied in the general hospitalized population. The objectives of this study are to derive and validate a predictive score for hospital-acquired acute kidney injury (HAKI). We conducted a case-controlled study of HAKI involving 180 cases and 360 controls. A multivariate logistic regression model was developed in two-thirds of the subjects and validated in the other third. Upon admission, cases in the developmental sample were older (67 vs. 63 yrs, p = .008) and more likely to have diabetes (51% vs. 35%; p = .003), hypertension (77% vs. 60%, p = .001), heart failure (34% vs. 20%, p = .004), blood urea nitrogen ≥25 mg/dL (38% vs. 20%, p = <.001), creatinine ≥1.1 mg/dL (65% vs. 39%; p <.001), albumin ≤4 g/dL (85% vs. 71%; p = .033), and bicarbonate <24 mEq/L or >30 mEq/L (42% vs. 29%; p = .05) compared to controls. The final risk score included pulse, bicarbonate, creatinine, and specific medications (NSAIDs, ACE inhibitors, ARBs, and/or diuretics). The c-statistic for the risk score in the developmental sample was 0.69. In the validation sample, an increasing number of risk factors was associated with increased risk of HAKI (16% and 62% in the low and high-risk groups, respectively). In conclusion, a simple model based on readily available data stratifies patients according to their risk of developing HAKI and may guide clinical decision making and provide a basis for further research into HAKI.

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Section: Discussionmentioning

confidence: 63%

Predicting Hospital-Acquired Acute Kidney Injury—A Case-Controlled Study

2008

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“…21 Moreover few studies identified risk factors for postoperative ARF in cardiac 22 and liver transplant patients, but without developing prediction rules. 8,11,13 Therefore, the aim of this study was to develop and validate a simple and readily applicable score based on preoperative parameters to predict postoperative ARF in patients scheduled for liver resection.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] Reported incidences of postoperative ARF range from 1 % after major non-cardiac surgery without liver resection 3 to around 20% after cardiac surgery [4][5][6] and up to 50% after liver transplantation. [7][8][9][10][11][12][13] The comparability of postoperative ARF across different studies is difficult due to a lack of standardized definition of ARF. Only very limited data exists regarding the occurrence of ARF in patients after liver resection, as well as its impact on outcome.…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of a Prediction Score for Postoperative Acute Renal Failure Following Liver Resection

et al. 2009

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Development and validation of a prediction score for postoperative acute renal failure following liver resection Abstract OBJECTIVE: To develop and validate a score to predict postoperative acute renal failure (ARF) after liver resection. BACKGROUND: Postoperative ARF after major surgery is associated with morbidity and mortality. Early identification of patients at risk of ARF is important in order to provide protective kidney treatment. METHODS: Postoperative ARF was prospectively assessed in consecutive patients undergoing liver resection. In randomly selected two-third of the total number of patients, multivariate logistic regression analysis was used to develop a new prediction score (including a full and a reduced model), based on the preoperative parameters of age, gender, preexisting chronic renal dysfunction, cardiovascular disease, diabetes, bilirubin, and alanine aminotransferase (ALT) levels. In the remaining last third of the patients, the new score was validated by calibrating the accuracy of the score (ClinicalTrials.gov NCT 00743132). RESULTS: Postoperative ARF occurred in 15.1% (86 of 569 consecutive patients) from 2002 to 2007 and was highly associated with mortality (22.5% vs. 0.8% without ARF, P < 0.001). In the 380 (two-third of the population) patients selected for the development of the prediction score, preoperatively elevated ALT, preexisting cardiovascular disease, chronic renal failure, and diabetes were the strongest predictors of ARF. Validating the full prediction model (0-22 points) to the remaining 189 patients (one-third of the population), the risk could be predicted accurately (mean predicted risk of 11.5% vs. an observed risk of 14.8%) without significant differences between predicted and observed risks across different risk categories (P = 0.98). Prediction with the reduced model including the 4 strongest predictors (0-7 points) was almost as accurate as with the full model (11.4% predicted vs. 14.8% observed) and also without significant differences across different risk categories (P = 0.75). CONCLUSIONS: The new prediction score (the full as well as the reduced model) accurately predicted postoperative ARF after liver resection. The use of these scores allows early identification of patients at high risk of ARF, and may support decision making for protective kidney interventions perioperatively. MINI ABSTRACTPostoperative acute renal failure (ARF) is associated with high morbidity and mortality. The new prediction score, including a full as well as a reduced model, accurately predicted ARF after liver resection. This score allows early identification of patients at high risk of ARF and may support decision-making for protective kidney interventions. To develop and validate a score to predict postoperative acute renal failure (ARF) after liver resection.Background:

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“…The 15,17 , preoperative decreased renal function 7,17 , hemocomponents transfusion 1,5,18 , postreperfusion syndrome 5,19 and surgical technique 1,2 have been highlighted in the most current literature. Some preoperative co-morbidity such as hypertension, obesity (i.e.…”

Section: Discussionmentioning

confidence: 99%

Postoperative kidney injury does not decrease survival after liver transplantation

Fonseca-Neto

Miranda²,

Batista³

et al. 2012

Acta Cir. Bras.

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PURPOSE:To explore the effect of acute kidney injury (AKI) on long-term survival after conventional orthotopic liver transplantation (OLT) without venovenous bypass (VVB). METHODS: A retrospective cohort study was carried out on 153 patients with end-stage liver diseases transplanted by the Department of General Surgery and Liver Transplantation of the University of Pernambuco, from August, 1999 to December, 2009. The KaplanMeier survival estimates and log-rank test were applied to explore the association between AKI and long-term patient survival, and multivariate analyses were applied to control the effect of other variables. RESULTS: Over the 12.8-year follow-up, 58.8% patients were alive with a median follow-up of 4.5-year. Patient 1-, 2-, 3-and 5-year survival were 74.5%, 70.6%, 67.9% and 60.1%; respectively. Early postoperative mortality was poorer amongst patients who developed AKI (5.4% vs. 20%, p=0.010), but long-term 5-year survival did not significantly differed between groups (51.4% vs. 65.3%; p=0.077). After multivariate analyses, AKI was not significantly related to long-term survival and only the intraoperative transfusion of red blood cells was significantly related to this outcome (non-adjusted Exp[b]=1.072; p=0.045). CONCLUSION: The occurrence of postoperative acute kidney injury did not independently decrease patient survival after orthotopic liver transplantation without venovenous bypass in this data from northeast Brazil. Key words: Liver Transplantation. Renal Insufficiency. Prognosis RESUMO OBJETIVO: Explorar o efeito da insuficiência renal aguda (IRA) na sobrevivência de longo prazo após o transplante hepático convencional ortotópico (THC) sem desvio venovenoso (DVV). MÉTODOS: Estudo de coorte retrospectivo envolvendo153 pacientes portadores de doença hepática terminal transplantados pelo Departamento de Cirurgia Geral e Transplante Hepático da Universidade de Pernambuco, no período de agosto de 1999 a dezembro de 2009. O método de Kaplan-Meier e o teste log-rank foram aplicados para explorar a associação entre o IRA com a sobrevivência de longo prazo dos pacientes, aplicando-se o modelo multivariado de riscos proporcionais de Cox para controlar o efeito de outras variáveis. RESULTADOS: A proservação atingiu 12,8 anos, durante a qual 58,8% dos pacientes permaneceram vivos com mediana de acompanhamento de 4,5 anos. As taxas de sobrevivência cumulativa de 1 -, 2 -, 3 -e 5 anos foram de 74,5%, 70,6%, 67,9% e 60,1%; respectivamente. A taxa de mortalidade pós-operatória precoce foi maior entre os pacientes que desenvolveram IRA (5,4% vs. 20%, p = 0,010), mas a sobrevivência de longoprazoem5 anos não diferiu significativamente entre os grupos (51,4% vs. 65,3%, p = 0,077). Após análise multivariada, a IRA nãofoisignificativamenterelacionado à sobrevivência a longo prazo e apenas transfusão intra-operatório de hemácias foi significativamente relacionado com este desfecho (Exp [b] não-ajustado = 1,072, p = 0,045). CONCLUSÃO: A ocorrência de insuficiência renal aguda pós-operatória não d...

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Risk factors of acute renal failure after liver transplantation

Cited by 273 publications

References 32 publications

Predicting Hospital-Acquired Acute Kidney Injury—A Case-Controlled Study

Predicting Hospital-Acquired Acute Kidney Injury—A Case-Controlled Study

Development and Validation of a Prediction Score for Postoperative Acute Renal Failure Following Liver Resection

Postoperative kidney injury does not decrease survival after liver transplantation

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