The Association Between Vena Cava Implantation Technique and Acute Kidney Injury After Liver Transplantation

Abstract

Background. Acute kidney injury (AKI) after liver transplantation is associated with increased morbidity and mortality. It remains controversial whether the choice of vena cava reconstruction technique impacts AKI. Methods. This is a single-center retrospective cohort of 897 liver transplants performed between June 2009 and September 2018 using either the vena cava preserving piggyback technique or caval replacement technique without veno-venous bypass or shunts. The association between vena cava reconstruction technique and stage of postoperative AKI was assessed using multivariable ordinal logistic regression. Causal mediation analysis was used to evaluate warm ischemia time as a potential mediator of this association. Results. The incidence of AKI (AKI stage ≥2) within 48 h after transplant was lower in the piggyback group (40.3%) compared to the caval replacement group (51.8%, P < 0.001). Piggyback technique was associated with a reduced risk of developing a higher stage of postoperative AKI (odds ratio, 0.49; 95% confidence interval, 0.37-0.65, P < 0.001). Warm ischemia time was shorter in the piggyback group and identified as potential mediator of this effect. There was no difference in renal function (estimated glomerular filtration rate and the number of patients alive without dialysis) 1 y after transplant. Conclusions. Piggyback technique, compared with caval replacement, was associated with a reduced incidence of AKI after liver transplantation. There was no difference in long-term renal outcomes between the 2 groups.

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

“…The formula for the Model for End-Stage Liver Disease (MELD) score is: 3.8 × log e (bilirubin [mg/dL]) + 11.2 × log e (INR) + 9.6 × log e (sCr [mg/dL]) + 6.4×(etiology: 0 if cholestatic or alcoholic, 1 otherwise) [ 21 ]. The estimated glomerular filtration rate (eGFR) was calculated according to the Modification of Diet in Renal Disease (MDRD) equation [ 22 ]. CKD was defined as eGFR <60 mL/min/1.73 m 2 for 3 months, regardless of the presence or absence of structural kidney damage [ 23 ].…”

Post–Liver Transplant Acute Kidney Injury

“…(50) Several studies have demonstrated reduced rates of postoperative AKI when the piggyback technique is used. (51,52) The use of a venovenous bypass also appears to prevent AKI following transplant. (53) pOstOpeRAtive FActORs…”

“…For patients who are undergoing LT with preoperative AKI, consider using the piggyback vena caval implantation technique or venovenous bypass as a way to reduce the further worsening of AKI. (52,53) Both techniques can reduce renal congestion and a decline in cardiac output during the vena caval implantation portion of LT.…”

Not All Piggybacks Are Equal: A Retrospective Cohort Analysis of Variation in Anhepatic Transcaval Pressure Gradient and Acute Kidney Injury During Liver Transplant

“…1 Compared with CR, the PB approach has been proposed to reduce the incidence of acute kidney injury (AKI) and organ dysfunction as a consequence of preservation of venous return. 2 However, a review by Gurusamy and colleagues in 2011 identified no differences in renal failure, liver graft function, or mortality between these surgical approaches. In addition, studies that compared the incidence of AKI after these approaches have reported conflicting results.…”