Acute Renal Injury Evaluation after Liver Transplantation: With RIFLE Criteria


AKSU ERDOST H., ÖZKARDEŞLER S., ÖÇMEN E., AVKAN OĞUZ V., Akan M., Iyilikci L., ...More

Transplantation Proceedings, vol.47, no.5, pp.1482-1487, 2015 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Abstract
  • Volume: 47 Issue: 5
  • Publication Date: 2015
  • Doi Number: 10.1016/j.transproceed.2015.04.065
  • Journal Name: Transplantation Proceedings
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.1482-1487
  • Dokuz Eylül University Affiliated: Yes

Abstract

© 2015 Elsevier Inc. All rights reserved.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.