title: Acute Renal Injury Evaluation After Liver Transplantation: With RIFLE Criteria.
abstract: BACKGROUND
  The aim of this study was to identify acute renal injury (ARI) through the use of RIFLE (risk, injury, failure, loss, end-stage kidney disease) criteria and to investigate perioperative risk factors for ARI in liver transplantation (LT).
  
  
  METHODS
  We reviewed medical records of adult LT patients retrospectively. Postoperative ARI was staged with RIFLE criteria by the 1st and 7th days of the surgery.
  
  
  RESULTS
  We analyzed 440 adult LT patients, categorized as risk (R), injury (I), or failure (F) according to the RIFLE criteria. In this study, in the first postoperative day, incidence of ARI was 7.95%; all of them were R-class, and, on the 7th day, the incidence of ARI was 7.27%, as R-class 6.59% and I-class 0.68%. Significant risk factors were detected within the first postoperative day including pre-operative hemoglobin levels <9 g/dL (P = .019), intra-operative transfusion of red blood cells (RBCs) (P = .049) and fresh-frozen plasma (FFP) (P = .049), blood loss (P = .011), and post-reperfusion syndrome (P = .023). Multivariate analysis revealed risk factors for ARI as RBCs (odds ratio [OR], 1.049; P = .247) and FFP (OR, 1.017; P = .627) transfusion and blood loss (OR, 1.000; P = .021) (blood loss OR: 0.9996952300184; 95% confidence interval: 0.9994356774026 to 0.999548500399). The only significant risk factor for the 7th postoperative day was the Model for End-Stage Liver Disease (MELD) score (>20) (P = .002).
  
  
  CONCLUSIONS
  This study showed that RBC and FFP transfusion, perioperative blood loss, and MELD score >20 are risk factors for LT-related ARI. Also normalization of hemoglobin levels with non-blood products in patients with preoperative low hemoglobin levels can diminish the need for RBC and that can prevent ARI.
authors.affiliation: Department of Anesthesiology and Reanimation, School of Medicine, Dokuz Eylul University, Izmir, Turkey. Electronic address: haleaksu78@yahoo.com.
authors.forename: H
authors.initials: H
authors.lastname: Aksu Erdost
authors.affiliation: Department of Anesthesiology and Reanimation, School of Medicine, Dokuz Eylul University, Izmir, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Ozkardesler
authors.affiliation: Department of Anesthesiology and Reanimation, School of Medicine, Dokuz Eylul University, Izmir, Turkey.
authors.forename: E
authors.initials: E
authors.lastname: Ocmen
authors.affiliation: Department of Infectious Disease and Clinical Microbiology, School of Medicine, Dokuz Eylul University, Izmir, Turkey.
authors.forename: V
authors.initials: V
authors.lastname: Avkan-Oguz
authors.affiliation: Department of Anesthesiology and Reanimation, School of Medicine, Dokuz Eylul University, Izmir, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Akan
authors.affiliation: Department of Anesthesiology and Reanimation, School of Medicine, Dokuz Eylul University, Izmir, Turkey.
authors.forename: L
authors.initials: L
authors.lastname: Iyilikci
authors.affiliation: Department of General Surgery, School of Medicine, Dokuz Eylül University, Izmir, Turkey.
authors.forename: T
authors.initials: T
authors.lastname: Unek
authors.affiliation: Department of General Surgery, School of Medicine, Dokuz Eylül University, Izmir, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Ozbilgin
authors.affiliation: Department of Nutrition and Dietetics, Faculty of Science, Ege University, Izmir, Turkey.
authors.forename: R
authors.initials: R
authors.lastname: Meseri Dalak
authors.affiliation: Department of General Surgery, School of Medicine, Dokuz Eylül University, Izmir, Turkey.
authors.forename: I
authors.initials: I
authors.lastname: Astarcioglu
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D014421:Turkey / Q000453:epidemiology