The relationship between preoperative creatinine clearance and outcomes for patients undergoing liver transplantation: a retrospective observational study

Abstract

BackgroundRenal failure with following continuous renal replacement therapy is a major clinical problem in liver transplant recipients, with reported incidences of 3% to 20%. Little is known about the significance of postoperative acute renal failure or acute-on-chronic renal failure to postoperative outcome in liver transplant recipients.MethodsIn this post hoc analysis we compared the mortality rates of 135 consecutive liver transplant recipients over 6 years in our center subject to their renal baseline conditions and postoperative RRT. We classified the patients into 4 groups, according to their preoperative calculated Cockcroft formula and the incidence of postoperative renal replacement therapy. Data then were analyzed in regard to mortality rates and in addition to pre- and peritransplant risk factors.ResultsThere was a significant difference in ICU mortality (p=.008), hospital mortality (p=.002) and cumulative survival (p<.0001) between the groups. The highest mortality rate occurred in the group with RRT and normal baseline kidney function (20% ICU mortality, 26.6% hospital mortality and 50% cumulative 1-year mortality, respectively). The hazard ratio in this group was 9.6 (CI 3.2-28.6, p=.0001).ConclusionThis study shows that in liver transplant recipient’s acute renal failure with postoperative RRT is associated with mortality and the mortality rate is higher than in patients with acute-on-chronic renal failure and postoperative renal replacement therapy.

Risk factors of acute kidney injury after orthotopic liver transplantation in China

“…In the present study, we found an obvious difference between the AKI and non-AKI groups, regarding intraoperative blood loss, transfusion of blood products, cold or warm ischemia time, and total volume of intravenous infusion. These findings were consistent with previous studies 6 16 18 19 24 25 49 . However, regarding the duration of surgery, no significant difference was found between groups in our results, but some studies 17 32 53 inferred that this can be attributed to post-OLT AKI.…”

“…Wenger et al . 25 have confirmed that many intraoperative data like duration of surgery and blood transfusion volume were independent factors contributing to post-OLT AKI. Here, we also observed a significant difference between groups in cold ischemia time (7 vs 6.17 h, P = 0.043), warm ischemia time (5 vs 5 min, P < 0.001), intraoperative blood loss (2500 vs 1600 mL, P < 0.001), red blood cells (2000 vs 1600 mL, P < 0.001), autologous blood cell transfusion (1225 vs 800 mL, P = 0.015), fresh frozen plasma (1850 vs 1450 mL, P < 0.001), and total intravenous infusion (6611.5 vs 5500 mL, P < 0.001).…”

“…Meanwhile, some investigations revealed that postoperative infection 19 , RRT induction 14 were independent risk factors of AKI complicated to OLT. However, some risk factors, which may cause AKI after OLT, are still controversial or even contradicting in different investigations 6 11 16 17 20 21 22 23 24 25 .…”

Association of intraoperative transfusion of blood products with mortality in lung transplant recipients

“…Indications for ECMO were exactly as described previously [8] and for RRT the occurrence of risk, injury, failure, loss, end-stage renal disease (RIFLE) class 2 (injury), as we use routinely in our transplant programme [5,9]. …”

Pretransplant urinary proteome analysis does not predict development of chronic kidney disease after liver transplantation

“…Wenger et al . showed that intraoperative blood transfusion was not associated with impaired kidney function in patients with normal baseline kidney function . Proteome analysis early after liver transplantation might be interesting to predict the development of CKD and to detect events induced either by the transplantation itself and/or the immunosuppressive regimen that can lead to CKD.…”