Risk factors of acute renal failure after orthotopic liver transplantation: single-center experience.
BACKGROUND
Acute renal failure (ARF) is one of the most significant complications of orthotopic liver transplantation (OLT), associated with increased mortality rate and the development of chronic renal dysfunction. The aim of the study was to determine the perioperative risk factors for ARF in patients without previous history of renal disease who are undergoing OLT.


METHODS
Forty-six patients who developed ARF after OLT performed in 1 transplant center were included in the study, and 52 consecutive patients without that complication served as a control group. Renal dysfunction was defined as a glomerular filtration rate <60 mL/min/1.73 m(2). The data concerning preoperative diseases, perioperative renal function, first-line immunosuppressive therapy, and blood transfusion requirement were retrospectively analyzed and compared among groups. Logistic regression modeling was used to determine risk factors for ARF.


RESULTS
Patients who developed ARF were significantly older (mean age 53.3 vs 46.3 years, P = .057), had higher level of preoperative (0.79 vs 0.71 mg/dL, P = .0062) and intraoperative (0.85 vs 0.74 mg/dL, P = .0045) creatinine. The risk factors for ARF were intraoperative and 24-hour post-transplant creatinine level >0.9 mg/dL and high-dose tacrolimus-based immunosuppression. Transfusion of ≤6 units of red blood cells diminished the risk of ARF. Sex and preoperative diseases were not predictive to ARF in our regression models.


CONCLUSIONS
Careful operative technique with low blood loss and immunosuppressive therapy of low nephrotoxic potential should be recommended in older patients to diminish the risk of renal dysfunction after orthotopic liver transplantation. Patients with higher levels of perioperative creatinine should be considered to have first-line immunosuppression without calcineurin inhibitors or with low-dose immunosuppressants of known nephrotoxic potential.
Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Poland. Electronic address: piotrsmoter@gmail.com.
P
P
Smoter
Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Poland.
P
P
Nyckowski
Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Poland.
M
M
Grat
Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Poland.
W
W
Patkowski
Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Poland.
K
K
Zieniewicz
Students' Scientific Group, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Poland.
K
K
Wronka
Students' Scientific Group, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Poland.
B
B
Hinderer
Students' Scientific Group, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Poland.
M
M
Morawski
D058186:Acute Kidney Injury / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D000328:Adult; D000367:Age Factors; D000368:Aged; D003404:Creatinine / Q000097:blood*; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007674:Kidney Diseases; D016031:Liver Transplantation / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016559:Tacrolimus / Q000627:therapeutic use*
D007166:Immunosuppressive Agents; D003404:Creatinine; D016559:Tacrolimus