title: Acute kidney injury and post-reperfusion syndrome in liver transplantation.
abstract: In the past decades liver transplantation (LT) has become the treatment of choice for patients with end stage liver disease (ESLD). The chronic shortage of cadaveric organs for transplantation led to the utilization of a greater number of marginal donors such as older donors or donors after circulatory death (DCD). The improved survival of transplanted patients has increased the frequency of long-term complications, in particular chronic kidney disease (CKD). Acute kidney injury (AKI) post-LT has been recently recognized as an important risk factor for the occurrence of de novo CKD in the long-term outcome. The onset of AKI post-LT is multifactorial, with pre-LT risk factors involved, including higher Model for End-stage Liver Disease score, more sever ESLD and pre-existing renal dysfunction, either with intra-operative conditions, in particular ischaemia reperfusion injury responsible for post-reperfusion syndrome (PRS) that can influence recipient's morbidity and mortality. Post-reperfusion syndrome-induced AKI is an important complication post-LT that characterizes kidney involvement caused by PRS with mechanisms not clearly understood and implication on graft and patient survival. Since pre-LT risk factors may influence intra-operative events responsible for PRS-induced AKI, we aim to consider all the relevant aspects involved in PRS-induced AKI in the setting of LT and to identify all studies that better clarified the specific mechanisms linking PRS and AKI. A PubMed search was conducted using the terms liver transplantation AND acute kidney injury; liver transplantation AND post-reperfusion syndrome; acute kidney injury AND post-reperfusion syndrome; acute kidney injury AND DCD AND liver transplantation. Five hundred seventy four articles were retrieved on PubMed search. Results were limited to title/abstract of English-language articles published between 2000 and 2015. Twenty-three studies were identified that specifically evaluated incidence, risk factors and outcome for patients developing PRS-induced AKI in liver transplantation. In order to identify intra-operative risk factors/mechanisms specifically involved in PRS-induced AKI, avoiding confounding factors, we have limited our study to "acute kidney injury AND DCD AND liver transplantation". Accordingly, three out of five studies were selected for our purpose.
authors.affiliation: Ilaria Umbro, Francesca Tinti, Anna Paola Mitterhofer, Department of Clinical Medicine, Nephrology and Dialysis B, Sapienza University of Rome, 00185 Rome, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Umbro
authors.affiliation: Ilaria Umbro, Francesca Tinti, Anna Paola Mitterhofer, Department of Clinical Medicine, Nephrology and Dialysis B, Sapienza University of Rome, 00185 Rome, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Tinti
authors.affiliation: Ilaria Umbro, Francesca Tinti, Anna Paola Mitterhofer, Department of Clinical Medicine, Nephrology and Dialysis B, Sapienza University of Rome, 00185 Rome, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Scalera
authors.affiliation: Ilaria Umbro, Francesca Tinti, Anna Paola Mitterhofer, Department of Clinical Medicine, Nephrology and Dialysis B, Sapienza University of Rome, 00185 Rome, Italy.
authors.forename: Felicity
authors.initials: F
authors.lastname: Evison
authors.affiliation: Ilaria Umbro, Francesca Tinti, Anna Paola Mitterhofer, Department of Clinical Medicine, Nephrology and Dialysis B, Sapienza University of Rome, 00185 Rome, Italy.
authors.forename: Bridget
authors.initials: B
authors.lastname: Gunson
authors.affiliation: Ilaria Umbro, Francesca Tinti, Anna Paola Mitterhofer, Department of Clinical Medicine, Nephrology and Dialysis B, Sapienza University of Rome, 00185 Rome, Italy.
authors.forename: Adnan
authors.initials: A
authors.lastname: Sharif
authors.affiliation: Ilaria Umbro, Francesca Tinti, Anna Paola Mitterhofer, Department of Clinical Medicine, Nephrology and Dialysis B, Sapienza University of Rome, 00185 Rome, Italy.
authors.forename: James
authors.initials: J
authors.lastname: Ferguson
authors.affiliation: Ilaria Umbro, Francesca Tinti, Anna Paola Mitterhofer, Department of Clinical Medicine, Nephrology and Dialysis B, Sapienza University of Rome, 00185 Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Muiesan
authors.affiliation: Ilaria Umbro, Francesca Tinti, Anna Paola Mitterhofer, Department of Clinical Medicine, Nephrology and Dialysis B, Sapienza University of Rome, 00185 Rome, Italy.
authors.forename: Anna Paola
authors.initials: AP
authors.lastname: Mitterhofer
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D000818:Animals; D046148:Donor Selection; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D015427:Reperfusion Injury / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D012307:Risk Factors; D013577:Syndrome; D014019:Tissue Donors / Q000600:supply & distribution; D016896:Treatment Outcome
keywords: Acute kidney injury; Chronic kidney disease; Donation after circulatory death; Liver transplantation; Post-reperfusion syndrome