title: Rifle criteria for acute kidney dysfunction following liver transplantation: incidence and risk factors.
abstract: RIFLE criteria have been used to determine the incidence of acute kidney dysfunction (AKD) after orthotopic liver transplantation (OLT). However, no studies have focused on the incidence of AKD after OLT in patients with normal pre-OLT kidney functions. Using the RIFLE criteria, we determined the incidence and risk factors for AKD after OLT in patients with normal pre-OLT kidney function. We retrospectively analyzed the records of 112 patients who underwent OLT from January 2000 to February 2009 with normal prior kidney function. We investigated three levels of renal dysfunction outlined in the RIFLE criteria: risk (R); injury (I); and failure (F). Preoperative, intraoperative, and postoperative variables were collected. AKD occurred in 64 (57%) OLTs with risk, injury, and failure frequencies of 19%, 11%, and 28%, respectively. Compared with those who did not develop AKD postoperatively, those who did had significantly higher MELD scores (19 ± 7 vs 16 ± 8; P = .018), more frequently use of inotropic agents intraoperatively (54% vs 35%; P = .070), more colloid treatment (300 ± 433 mL vs 105 ± 203 mL; P = .007), longer anhepatic phase (88.0 ± 42.0 minutes vs 73.0 ± 20.0 minutes; P = .037), and a greater incidence of intraoperative acidosis (64% vs 44%; P = .047). Logistic regression analysis revealed that MELD score (odds ratio 1.107, 95% CI 1.022-1.200, P = .013), duration of anhepatic phase (odds ratio 1.020 95% CI 1.000-1.040, P = .053), and intraoperative acidosis (odds ratio 0.277 95% CI 0.093-0.825 P = .021) were independent risk factors for AKD. In conclusion, our results suggested that, based on RIFLE criteria, AKD occurs in more than half of OLTs postoperatively. A higher MELD score, longer anhepatic phase, and occurrence of intraoperative acidosis were associated with AKD.
authors.affiliation: Department of Anesthesiology, Baskent University Faculty of Medicine, Ankara, Turkey. aycan.k@gmail.com
authors.forename: A
authors.initials: A
authors.lastname: Kundakci
authors.forename: A
authors.initials: A
authors.lastname: Pirat
authors.forename: O
authors.initials: O
authors.lastname: Komurcu
authors.forename: A
authors.initials: A
authors.lastname: Torgay
authors.forename: H
authors.initials: H
authors.lastname: Karakayalı
authors.forename: G
authors.initials: G
authors.lastname: Arslan
authors.forename: M
authors.initials: M
authors.lastname: Haberal
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation / Q000009:adverse effects*; D012307:Risk Factors; D012720:Severity of Illness Index