title: Hepatic ischemia reperfusion injury is associated with acute kidney injury following donation after brain death liver transplantation.
abstract: Donation after cardiac death liver transplant recipients have an increased frequency of acute kidney injury (AKI). This suggests that hepatic ischemia-reperfusion injury may play a critical role in the pathogenesis of AKI after liver transplantation. The aim of this single-center study was to determine if hepatic ischemia-reperfusion injury, estimated by peak peri-operative serum amino-transferase (AST), is associated with AKI following donation after brain death (DBD) liver transplantation. A total of 296 patients received 298 DBD liver transplants from January 2007 to June 2011. The incidence of AKI was 35.9%. AKI was a risk factor for chronic kidney disease (P = 0.037) and mortality (P = 0.002). On univariate analysis, peak AST correlated with peak creatinine (P < 0.001) and peak change in creatinine from baseline (P < 0.001). Peak AST was higher in AKI patients (P < 0.001). The incidence of AKI in patients with a peak AST of <1500, 1500-2999 and ≥ 3000 U/l was 26.1%, 39.8% and 71.2%, respectively (P < 0.001). On multiple logistic regression analysis, peak AST was independently associated with the development of AKI (P < 0.001). In conclusion, hepatic ischemia-reperfusion injury demonstrates a strong relationship with peri-operative AKI in DBD liver transplant recipients.
authors.affiliation: Liver Unit, Queen Elizabeth Hospital, Birmingham, UK; NIHR Biomedical Research Unit and Centre for Liver Research, University of Birmingham, Birmingham, UK.
authors.forename: Joanna A
authors.initials: JA
authors.lastname: Leithead
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Armstrong
authors.forename: Christopher
authors.initials: C
authors.lastname: Corbett
authors.forename: Mark
authors.initials: M
authors.lastname: Andrew
authors.forename: Chirag
authors.initials: C
authors.lastname: Kothari
authors.forename: Bridget K
authors.initials: BK
authors.lastname: Gunson
authors.forename: Paolo
authors.initials: P
authors.lastname: Muiesan
authors.forename: James W
authors.initials: JW
authors.lastname: Ferguson
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology* / Q000401:mortality; D000328:Adult; D001219:Aspartate Aminotransferases / Q000097:blood; D001926:Brain Death / Q000503:physiopathology; D005260:Female; D006801:Humans; D007668:Kidney / Q000502:physiology; D008099:Liver / Q000473:pathology; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D015427:Reperfusion Injury / Q000150:complications* / Q000503:physiopathology
chemical_list: D001219:Aspartate Aminotransferases
keywords: acute kidney injury; chronic kidney disease; donation after brain death; ischemia reperfusion injury; liver transplantation