title: The postreperfusion syndrome is associated with acute kidney injury following donation after brain death liver transplantation.
abstract: Acute kidney injury (AKI) is frequently observed after donation after brain death (DBD) liver transplantation (LT) and associated with impaired recipient survival and chronic kidney disease. Hepatic ischemia/reperfusion injury (IRI) is suggested to be an important factor in this process. The postreperfusion syndrome (PRS) is the first manifestation of severe hepatic IRI directly after reperfusion. We performed a retrospective study on the relation between hepatic IRI and PRS and their impact on AKI in 155 DBD LT recipients. Severity of hepatic IRI was measured by peak postoperative AST levels and PRS was defined as >30% decrease in MAP ≥1 min within 5 min after reperfusion. AKI was observed in 39% of the recipients. AKI was significantly more observed in recipients with PRS (53% vs. 32%; P = 0.013). Median peak AST level was higher in recipients with PRS (1388 vs. 771 U/l; P < 0.001). Decrease in MAP after reperfusion correlated well with both severity of AKI (P = 0.012) and hepatic IRI (P < 0.001). Multiple logistic regression identified PRS as an independent factor for postoperative AKI (OR 2.28; 95% CI 1.06-4.99; P = 0.035). In conclusion, PRS reflects severe hepatic IRI and predicts AKI after DBD LT. PRS immediately after reperfusion is an early warning sign and creates opportunities to preserve postoperative renal function.
authors.affiliation: Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: Marit
authors.identifier: http://orcid.org/0000-0001-5280-1983
authors.initials: M
authors.lastname: Kalisvaart
authors.affiliation: Department of Adult Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: Jubi E
authors.initials: JE
authors.lastname: de Haan
authors.affiliation: Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Hesselink
authors.affiliation: Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: Wojciech G
authors.identifier: http://orcid.org/0000-0002-3096-4893
authors.initials: WG
authors.lastname: Polak
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: Bettina E
authors.initials: BE
authors.lastname: Hansen
authors.affiliation: Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: Jan N M
authors.initials: JNM
authors.lastname: IJzermans
authors.affiliation: Department of Adult Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: Diederik
authors.initials: D
authors.lastname: Gommers
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: Herold J
authors.initials: HJ
authors.lastname: Metselaar
authors.affiliation: Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: Jeroen
authors.initials: J
authors.lastname: de Jonge
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology* / Q000503:physiopathology; D000328:Adult; D001219:Aspartate Aminotransferases / Q000097:blood; D001794:Blood Pressure; D001926:Brain Death; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology; D015427:Reperfusion Injury / Q000209:etiology* / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D013577:Syndrome; D014019:Tissue Donors
chemical_list: D001219:Aspartate Aminotransferases
keywords: acute kidney injury; donation after brain death liver transplantation; hepatic ischemia/reperfusion injury; postreperfusion syndrome