Surgery, Gastroenterology and Oncology

Introduction: Liver transplantation (LT) represents the only definitive treatment in End-Stage Liver Disease (ESLD). Patient outcome, including quality of life after LT depends on perioperative outcome and reduction of postoperative complications. Many studies identified acute kidney injury (AKI) as one of the most frequent complications after liver transplantation with a negative impact on both short and long term survival, and focused on identifying risk factors for AKI. Our aim is to assess modifiable risk factors in a single national center in a country that is stii under development in order to improve our clinical practice.

Methods: We collected retrospective data from 112 patients who underwent liver transplantation at Fundeni Clinical Institute, Bucharest between January 2012 and May 2013. Patients with acute liver failure and pre-existing renal dysfunction were excluded. Analyzed data were: demographic variables, severity of ESLD (assessed by severity scores and paraclinical variables) and co-morbidities, intraoperative blood loss and transfusion, intraoperative haemodynamics and vasopressor requirements, postoperative incidence of AKI and chronic kidney disease (CKD) and outcome (Post Anaesthesia Care Unit Length of Stay and mortality).

Results: The overall incidence of postoperative AKI was 35.77% (n=39) in the 109 patients included in the final analysis: AKI I (64.10% n=25), AKI II (23.07% n=9) and AKI III (12.83% n=5). Variables that correlated with AKI included: recipient age (p = 0.006), cardiovascular disease (p = 0.015), MELD-Na score (p=0.035), bilirubin (p=0.016), albumin (p=0.048). Univariate analysis identified intraoperative blood loss (p=0.010), Packed Red Blood Cells (RBC) (p=0.006) and Fresh Frozen Plasma (FFP) (p=0.001) transfusion and high-dose vasopressor support (p=0.034) as predictors of AKI. One year survival was significantly reduced in the 39 patients with AKI (79,5%) compared to patients without AKI in the early postoperative period (92,3%).

Conclusion: In conclusion, patients age, serum bilirubin and albumin levels, MELD-Na score, co-existing cardiovascular disease and intraoperative high vasopressor support represent risk factors for AKI after LT. Therefore, it is essential to early identify and correct if possible- these factors in order to increase the efficiency of therapeutic management of renal disease.

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