The postreperfusion syndrome is associated with acute kidney injury following donation after brain death liver transplantation

Abstract

Acute kidney injury (AKI) is frequently observed after donation after brain death (DBD) liver transplantation (LT) and associated with impaired recipient survival and chronic kidney disease. Hepatic ischemia/reperfusion injury (IRI) is suggested to be an important factor in this process. The postreperfusion syndrome (PRS) is the first manifestation of severe hepatic IRI directly after reperfusion. We performed a retrospective study on the relation between hepatic IRI and PRS and their impact on AKI in 155 DBD LT recipients. Severity of hepatic IRI was measured by peak postoperative AST levels and PRS was defined as >30% decrease in MAP ≥1 min within 5 min after reperfusion. AKI was observed in 39% of the recipients. AKI was significantly more observed in recipients with PRS (53% vs. 32%; P = 0.013). Median peak AST level was higher in recipients with PRS (1388 vs. 771 U/l; P < 0.001). Decrease in MAP after reperfusion correlated well with both severity of AKI (P = 0.012) and hepatic IRI (P < 0.001). Multiple logistic regression identified PRS as an independent factor for postoperative AKI (OR 2.28; 95% CI 1.06-4.99; P = 0.035). In conclusion, PRS reflects severe hepatic IRI and predicts AKI after DBD LT. PRS immediately after reperfusion is an early warning sign and creates opportunities to preserve postoperative renal function.

Chronic Kidney Disease After Liver Transplantation: Impact of Extended Criteria Grafts

“…Although there is a link between the use of ECD grafts and the posttransplant AKI, which is a risk factor for the development of CKD after liver transplantation, no direct relation between the use of these grafts and CKD has been observed in either this study or in previous studies. As shown in our previous studies, severe AKI (KDIGO stages 2 and 3) has the most significant impact on longterm graft and patient survival rates . In the present study, we highlighted the importance of the severity of AKI and development of CKD.…”

“…As shown in our previous studies, severe AKI (KDIGO stages 2 and 3) has the most significant impact on longterm graft and patient survival rates. (19,29) In the present study, we highlighted the importance of the severity of AKI and development of CKD. Recipients with only mild AKI (KDIGO stage 1) did not have an increased risk to develop CKD, whereas recipients with severe AKI (KDIGO stages 2 and 3) had a 1.8-fold increased risk.…”

“…AKI was classified into 3 stages: stage 1, increase of ≥26.5 µmol/L or increase of 1.5‐1.9–fold from baseline; stage 2, increase of 2‐2.9–fold; or stage 3, increase of ≥3‐fold or increase in serum creatinine to ≥354 µmol/L or initiation of RRT. The peak serum alanine aminotransferase or aspartate aminotransferase level in the first 48 hours was used as a surrogate marker for hepatic ischemia/reperfusion injury . Early allograft dysfunction (EAD) was defined according to the Olthoff criteria .…”

“…The peak serum alanine aminotransferase or aspartate aminotransferase level in the first 48 hours was used as a surrogate marker for hepatic ischemia/ reperfusion injury. (19) Early allograft dysfunction (EAD) was defined according to the Olthoff criteria. (20) Based on the Clavien-Dindo classification, all postoperative complications requiring treatment during initial hospital admission were collected and used to calculate the Comprehensive Complication Index (CCI) to assess postoperative morbidity.…”

Molecular profiling of postreperfusion milieu determines acute kidney injury after liver transplantation: A prospective study

“…Postreperfusion syndrome and hemodynamic instability have been associated with the development of AKI after LT . However, similarly to other studies, we did not find a significant difference in postreperfusion syndrome and hemodynamic instability between the AKI and non‐AKI groups.…”