title: Impact of RIFLE classification in liver transplantation.
abstract: Acute renal failure (ARF) is common after orthotopic liver transplantation (OLT). The aim of this study was to evaluate the prognostic value of RIFLE classification in the development of CKD, hemodialysis requirement, and mortality. Patients were categorized as risk (R), injury (I) or failure (F) according to renal function at day 1, 7 and 21. Final renal function was classified according to K/DIGO guidelines. We studied 708 OLT recipients, transplanted between September 1992 and March 2007; mean age 44 +/- 12.6 yr, mean follow-up 3.6 yr (28.8% > or = 5 yr). Renal dysfunction before OLT was known in 21.6%. According to the RIFLE classification, ARF occurred in 33.2%: 16.8% were R class, 8.5% I class and 7.9% F class. CKD developed in 45.6%, with stages 4 or 5d in 11.3%. Mortality for R, I and F classes were, respectively, 10.9%, 13.3% and 39.3%. Severity of ARF correlated with development of CKD: stage 3 was associated with all classes of ARF, stages 4 and 5d only with severe ARF. Hemodialysis requirement (23%) and mortality were only correlated with the most severe form of ARF (F class). In conclusion, RIFLE classification is a useful tool to stratify the severity of early ARF providing a prognostic indicator for the risk of CKD occurrence and death.
authors.affiliation: Transplantation Unit, Hospital de Curry Cabral, 1069-639 Lisboa, Portugal. karinadacostafer@hotmail.com
authors.forename: Ana Carina
authors.initials: AC
authors.lastname: Ferreira
authors.forename: Fernando
authors.initials: F
authors.lastname: Nolasco
authors.forename: Dulce
authors.initials: D
authors.lastname: Carvalho
authors.forename: Sandra
authors.initials: S
authors.lastname: Sampaio
authors.forename: Alexandre
authors.initials: A
authors.lastname: Baptista
authors.forename: Pedro
authors.initials: P
authors.lastname: Pessegueiro
authors.forename: Estela
authors.initials: E
authors.lastname: Monteiro
authors.forename: Luís
authors.initials: L
authors.lastname: Mourão
authors.forename: Eduardo
authors.initials: E
authors.lastname: Barroso
mesh_terms: D058186:Acute Kidney Injury / Q000145:classification* / Q000175:diagnosis* / Q000503:physiopathology; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome