[Factors related to renal dysfunction after liver transplantation in patients with normal preoperative function].
OBJECTIVE
To determine perioperative factors related to postoperative renal dysfunction in patients receiving liver transplants who had normal renal function before surgery.


METHODS
We analyzed the cases of 189 consecutive patients. Patients with hepatorenal syndrome and previously diagnosed renal insufficiency were excluded, as were patients undergoing a second transplant operation. Postoperative renal dysfunction was diagnosed when creatinine levels exceeded 1.5 mg x dL(-1) in the first postoperative week. Multivariate analysis of preoperative variables (patient characteristics; Child-Pugh score; status with the United Network for Organ Sharing; and sodium, coagulation, hemoglobin, and creatinine levels); intraoperative variables (blood product units required, duration of surgery, reperfusion syndrome, surgical technique, and crystalloids required); and postoperative variables (hemodialysis or filtration, reoperation, mortality, creatinine levels at 6 and 12 months).


RESULTS
One hundred fifty patients with normal kidney function were included. Postoperative renal dysfunction developed in 45 (30%). Differences between patients with and without postoperative renal dysfunction were found for weight; sex; Child-Pugh score; blood transfusion requirements (mean [SD] of 2.36 [2.4] units of packed red cells in the group of patients with renal dysfunction vs 1.3 [1.8] in the patients with normal function); and reperfusion syndrome (26 [66.7%] patients with renal dysfunction and 35 [21.5%] without). The last 2 variables continued to be significantly correlated with renal dysfunction in the multivariate analysis with a relative risk of 1.25, (95% confidence interval [CI], 1.01-1.55) for units of blood transfusion and 2.41 (95% CI, 1.04-5.57) for reperfusion syndrome. Renal replacement therapy was used in 4 patients (2.7%). Mortality rates were similar. At 6 and 12 months, 26 (17.3%) and 18 (12%) patients had renal dysfunction.


CONCLUSIONS
Acute renal dysfunction is a frequent complication following a liver transplant and it is associated with transfusion of more units of blood products even when the average transfusion amount is not large.
Koo
M
M
Unidad de Trasplante Hepático del Hospital Universitario de Bellvitge, Barcelona. maylin@eresmas.net
Sabaté
A
A
Ramos
E
E
Dalmau
A
A
León
E
E
Fabregat
J
J
Rafecas
A
A
D058186:Acute Kidney Injury / Q000097:blood / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D000768:Anesthesia, General / Q000379:methods; D001835:Body Weight; D003404:Creatinine / Q000097:blood; D004198:Disease Susceptibility; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D016031:Liver Transplantation / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000503:physiopathology; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D011229:Preanesthetic Medication; D011300:Preoperative Care; D011446:Prospective Studies; D017582:Renal Replacement Therapy; D012307:Risk Factors; D012737:Sex Factors; D013030:Spain / Q000453:epidemiology
D003404:Creatinine