Prevalence and predictors of acute kidney injury in liver transplant recipients

Background: Renal failure is a major impact factor of liver transplant outcome and renal function impairment predicts decreased survival, leading to increased morbidity and mortality. The aim of the study was to estimate the incidence, risk factors and resolution of acute kidney injury (AKI) in liver transplant recipients during post-operative hospital stay.
Material/Methods: We analyzed retrospectively data of 99 liver transplant recipients operated in 2008. Post-transplant occurrence of AKI was defined as  an increase in serum creatinine concentration (SCr) of 0.3 mg/dl or more (1.5 - fold from baseline). Recipient's age, aetiology of underlying liver disease, pre-transplant arterial hypertension, pre-transplant diabetes mellitus, pre-transplant SCr level, MELD score, Child-Pugh score, hypotension during operation, utilization of exogenous vasoconstrictors, number of packed red blood cells infused during operation were collected for each patient.
Results: AKI was observed in 31.31% of liver transplant recipients (31 patients). In this group mean increase in SCr was 2.49 (±0.78) fold from the baseline. Mean post-transplant SCr level was 2.59 (±0.92) mg/d. Renal replacement therapy was introduced in 16.12% (5 pts) of liver recipients developing AKI. Among them 2 pts (6.45%) died. Mean SCr level at the time of discharge from hospital was 1.17 (±0.57) mg/dl in the group of AKI in comparison with 0.77 (±0.32) in the group without AKI. Mean MELD score in AKI group was 17.19 (±7.65), mean Child-Pugh score 8.48 (±2.05). Mean number of packed red blood cells infused during operation was 4.89 (±3.71). Pre-transplant diabetes mellitus, Child-Pugh score, treatment with exogenous vasoconstrictors, number of packed red blood cells infused during operation correlated with occurrence of AKI in liver transplant recipients.
Conclusions: Our study demonstrates that AKI after liver transplantation is a relatively common complication. The Child-Pugh score, pre-transplant diabetes, treatment with exogenous vasoconstrictors, number of packed red blood cells infused during operation were identified as pre-transplant variables related to occurrence of AKI.

Keywords: Liver Transplantation