Comparison of acute kidney injury between ABO-compatible and ABO-incompatible living donor liver transplantation: A propensity matching analysis.
The anti-CD20 monoclonal antibody rituximab has significantly decreased the prevalence of antibody-mediated rejection of ABO-incompatible (ABOi) living donor liver transplantation (LDLT). However, little is known about acute kidney injury (AKI) following ABOi LDLT. The aim of this study was to identify the incidence of AKI in ABOi LDLT and compare it with that of ABO-compatible (ABOc) LDLT. We retrospectively collected and analyzed the data of 1617 patients who underwent liver transplant surgery from November 2008 to December 2014. Risk factors for AKI were investigated using multivariate regression analysis. In 271 ABOi LDLTs, AKI occurred in 184 (67.9%) according to Kidney Disease: Improving Global Outcomes criteria. After propensity score matching, the incidence of AKI was significantly higher after ABOi LDLT than after ABOc LDLT (67.0% versus 48.2%; P < 0.001). Furthermore, the intensive care unit stay (P = 0.01) was significantly prolonged, but there were no significant differences in mortality (P = 0.74), graft failure (P = 0.32), and postoperative dialysis (P = 0.74) between the 2 groups. Hemoglobin level and operation time were independent risk factors for AKI following ABOi LDLT. In conclusion, the incidence of AKI is higher in ABOi LDLT than ABOc LDLT. However, the impact of AKI on postoperative outcomes was not marked in our study. Therefore, ABOi LDLT in selected patients is promising with apparent good graft and survival outcomes. Liver Transplantation 22 1656-1665 2016 AASLD.
Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, University of Ulsan College of Medicine, Seoul, South Korea.
In-Gu
IG
Jun
Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, University of Ulsan College of Medicine, Seoul, South Korea.
Byungdoo
B
Lee
Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Seoul, South Korea.
Seon-Ok
SO
Kim
Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, University of Ulsan College of Medicine, Seoul, South Korea.
Won-Jung
WJ
Shin
Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, University of Ulsan College of Medicine, Seoul, South Korea.
Ji-Youn
JY
Bang
Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, University of Ulsan College of Medicine, Seoul, South Korea.
Jun-Gol
JG
Song
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Gi-Won
GW
Song
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Sung-Gyu
SG
Lee
Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, University of Ulsan College of Medicine, Seoul, South Korea.
Gyu-Sam
GS
Hwang
D000017:ABO Blood-Group System / Q000276:immunology*; D058186:Acute Kidney Injury / Q000097:blood / Q000453:epidemiology* / Q000276:immunology* / Q000628:therapy; D000328:Adult; D001787:Blood Group Incompatibility / Q000150:complications*; D046148:Donor Selection / Q000379:methods; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage / Q000627:therapeutic use; D015994:Incidence; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D057216:Propensity Score; D011446:Prospective Studies; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D000069283:Rituximab / Q000008:administration & dosage / Q000627:therapeutic use
D000017:ABO Blood-Group System; D006454:Hemoglobins; D007155:Immunologic Factors; D000069283:Rituximab