title: Risk factors for renal dysfunction in the postoperative course of liver transplant.
abstract: Renal dysfunction (RD) is a frequent complication after orthotopic liver transplantation (OLT), and it has an unfavorable effect on the prognosis of OLT patients. The purpose of our study was to identify possible risk factors for RD and its impact on survival. The possible relations of pre-, peri-, and postoperative variables to early-onset renal dysfunction (ED) (within the 1st 3 months), late-onset renal dysfunction (LD) (between 3 and 6 months), and chronic renal dysfunction (CRD) (beyond 6 months) was analyzed. We studied 245 liver transplants in 241 patients. RD was found in 64.1% of these patients, and 69% of the patients with RD recovered. LD was found in 16.7% of the transplant patients. In the multivariate analysis, baseline serum creatinine, perioperative volume of transfused bank-red blood cells, Acute Physiology and Chronic Health Evaluation (APACHE) II score at intensive care unit (ICU) admission, and infection were associated with the development of RD. Overall mortality was 27.8% and for the RD group, it was 33.5%. LD, but not ED, was related to lower survival (together with graft dysfunction and APACHE II score at ICU admission). In conclusion, ED is frequent alter OLT and is related to preexisting RD, the volume of transfused bank--red blood cells during surgery, higher APACHE II score at ICU admission, and infection. In general, the prognosis for ED is good, in contrast with that of LD, which is associated with diminished survival.
authors.affiliation: UCI Hospital Carlos Haya, Malaga, Spain. MIGUEL.LEBRON.G@terra.es
authors.forename: Miguel
authors.initials: M
authors.lastname: Lebrón Gallardo
authors.forename: Manuel E
authors.initials: ME
authors.lastname: Herrera Gutierrez
authors.forename: Gemma
authors.initials: G
authors.lastname: Seller Pérez
authors.forename: Emilio
authors.initials: E
authors.lastname: Curiel Balsera
authors.forename: Juan F
authors.initials: JF
authors.lastname: Fernández Ortega
authors.forename: Guillermo
authors.initials: G
authors.lastname: Quesada García
mesh_terms: D000328:Adult; D017707:Erythrocyte Transfusion / Q000009:adverse effects; D005260:Female; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D051437:Renal Insufficiency / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors