Acute Renal Injury Evaluation After Liver Transplantation: With RIFLE Criteria

Abstract Background The aim of this study was to identify acute renal injury (ARI) through the use of RIFLE (risk, injury, failure, loss, end-stage kidney disease) criteria and to investigate perioperative risk factors for ARI in liver transplantation (LT). Methods We reviewed medical records of adu...

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Bibliographic Details
Published in:	Transplantation proceedings Vol. 47; no. 5; pp. 1482 - 1487
Main Authors:	Aksu Erdost, H, Ozkardesler, S, Ocmen, E, Avkan-Oguz, V, Akan, M, Iyilikci, L, Unek, T, Ozbilgin, M, Meseri Dalak, R, Astarcioglu, I
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-06-2015
Subjects:	Acute Kidney Injury - diagnosis Acute Kidney Injury - epidemiology Acute Kidney Injury - etiology Female Humans Incidence Kidney Failure, Chronic - surgery Liver Transplantation - adverse effects Male Middle Aged Odds Ratio Retrospective Studies Risk Factors Surgery Turkey - epidemiology
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Summary:	Abstract Background The aim of this study was to identify acute renal injury (ARI) through the use of RIFLE (risk, injury, failure, loss, end-stage kidney disease) criteria and to investigate perioperative risk factors for ARI in liver transplantation (LT). Methods We reviewed medical records of adult LT patients retrospectively. Postoperative ARI was staged with RIFLE criteria by the 1st and 7th days of the surgery. Results We analyzed 440 adult LT patients, categorized as risk (R), injury (I), or failure (F) according to the RIFLE criteria. In this study, in the first postoperative day, incidence of ARI was 7.95%; all of them were R-class, and, on the 7th day, the incidence of ARI was 7.27%, as R-class 6.59% and I-class 0.68%. Significant risk factors were detected within the first postoperative day including pre-operative hemoglobin levels <9 g/dL ( P = .019), intra-operative transfusion of red blood cells (RBCs) ( P = .049) and fresh-frozen plasma (FFP) ( P = .049), blood loss ( P = .011), and post-reperfusion syndrome ( P = .023). Multivariate analysis revealed risk factors for ARI as RBCs (odds ratio [OR], 1.049; P = .247) and FFP (OR, 1.017; P = .627) transfusion and blood loss (OR, 1.000; P = .021) (blood loss OR: 0.9996952300184; 95% confidence interval: 0.9994356774026 to 0.999548500399). The only significant risk factor for the 7th postoperative day was the Model for End-Stage Liver Disease (MELD) score (>20) ( P = .002). Conclusions This study showed that RBC and FFP transfusion, perioperative blood loss, and MELD score >20 are risk factors for LT-related ARI. Also normalization of hemoglobin levels with non-blood products in patients with preoperative low hemoglobin levels can diminish the need for RBC and that can prevent ARI.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0041-1345 1873-2623
DOI:	10.1016/j.transproceed.2015.04.065