title: Incidence and outcomes of acute kidney injury in patients with hepatocellular carcinoma after liver transplantation.
abstract: OBJECTIVE
  To describe the incidence and outcomes linked with acute kidney injury (AKI) after liver transplantation (LT) in hepatocellular carcinoma (HCC) patients.
  
  
  METHODS
  From January 2003 to February 2011, HCC patients undergoing LT were retrospectively enrolled. Patient with a glomerular filtration rate (GFR) <60 mL/min/1.73 m2was excluded. AKI was defined and classified according to the AKIN criteria.
  
  
  RESULTS
  Of the 566 eligible patients, AKI was found in 109 (19.26%) patients (stage I, 66 cases; stage II, 15 cases; and stage III, 28 cases). Risk factors for AKI were the long anhepatic time (OR = 3.59, P = 0.009) and prolonged duration of systolic blood pressure (SBP) < 90 mmHg (OR = 1.07, P < 0.0001). Post-LT AKI was an independent risk factor associated with 30-day mortality (HR = 4.05, P = 0.047). Complete recovery occurred in 84 (77.06%) of all AKI episodes within 1 month after operation, while 25 patients (22.94%) suffered from prolonged AKI. Patients with prolonged AKI had a poorer 1-year survival than those with transient AKI (40 vs 86.90%; P < 0.0001). Patients with severe AKI more often developed prolonged AKI. 13 patients (52%) of the prolonged AKI progressed to chronic kidney disease (CKD) defined as eGFR <60 mL/min/1.73 m2after 1 year post-operation.
  
  
  CONCLUSIONS
  Post-LT AKI is not an uncommon complication. Intra-operative hemodynamic instability is crucial in the development of post-LT AKI and deserves more attention. Most post-LT AKI is transient and reversible, while the prolonged form may predict a decrease survival.
authors.affiliation: Blood Purification Center, Zhongshan Hospital of Fudan University, Shanghai, 200032, People's Republic of China.|Department of Nephrology, Zhongshan Hospital of Fudan University, Shanghai, 200032, People's Republic of China.|Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, 200032, People's Republic of China.|Shanghai Institute of Kidney and Dialysis, Shanghai, 200032, People's Republic of China.
authors.forename: Xiaohong
authors.initials: X
authors.lastname: Chen
authors.affiliation: Blood Purification Center, Zhongshan Hospital of Fudan University, Shanghai, 200032, People's Republic of China. ding.xiaoqiang@zs-hospital.sh.cn.|Department of Nephrology, Zhongshan Hospital of Fudan University, Shanghai, 200032, People's Republic of China. ding.xiaoqiang@zs-hospital.sh.cn.|Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, 200032, People's Republic of China. ding.xiaoqiang@zs-hospital.sh.cn.|Shanghai Institute of Kidney and Dialysis, Shanghai, 200032, People's Republic of China. ding.xiaoqiang@zs-hospital.sh.cn.
authors.forename: Xiaoqiang
authors.initials: X
authors.lastname: Ding
authors.affiliation: Blood Purification Center, Zhongshan Hospital of Fudan University, Shanghai, 200032, People's Republic of China.|Department of Nephrology, Zhongshan Hospital of Fudan University, Shanghai, 200032, People's Republic of China.|Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, 200032, People's Republic of China.|Shanghai Institute of Kidney and Dialysis, Shanghai, 200032, People's Republic of China.
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
authors.affiliation: Blood Purification Center, Zhongshan Hospital of Fudan University, Shanghai, 200032, People's Republic of China.|Department of Nephrology, Zhongshan Hospital of Fudan University, Shanghai, 200032, People's Republic of China.|Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, 200032, People's Republic of China.|Shanghai Institute of Kidney and Dialysis, Shanghai, 200032, People's Republic of China.
authors.forename: Jie
authors.initials: J
authors.lastname: Teng
authors.affiliation: Blood Purification Center, Zhongshan Hospital of Fudan University, Shanghai, 200032, People's Republic of China.|Department of Nephrology, Zhongshan Hospital of Fudan University, Shanghai, 200032, People's Republic of China.|Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, 200032, People's Republic of China.|Shanghai Institute of Kidney and Dialysis, Shanghai, 200032, People's Republic of China.
authors.forename: Jianzhou
authors.initials: J
authors.lastname: Zou
authors.affiliation: Department of Liver Surgery, Zhongshan Hospital of Fudan University, Shanghai, 200032, People's Republic of China.
authors.forename: Ting
authors.initials: T
authors.lastname: Wang
authors.affiliation: Department of Liver Surgery, Zhongshan Hospital of Fudan University, Shanghai, 200032, People's Republic of China.
authors.forename: Jian
authors.initials: J
authors.lastname: Zhou
authors.affiliation: Intensive Care Unit, Shanghai Public Health Clinical Center, Zhongshan Hospital of Fudan University, Shanghai, 200032, People's Republic of China.
authors.forename: Nan
authors.initials: N
authors.lastname: Chen
authors.affiliation: Liver Cancer Institute, Shanghai, 200032, People's Republic of China.
authors.forename: Boheng
authors.initials: B
authors.lastname: Zhang
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology*; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Acute kidney injury; Chronic kidney disease; Hepatocellular carcinoma; Liver transplantation; Mortality; Risk