Interaction between tacrolimus, MELD score and acute kidney injury after liver transplantation. Analysis on a large contemporary bicenter meld‐era series

2020 ◽  
Vol 34 (9) ◽  
Author(s):  
Rubén Ciria ◽  
Irene Gómez‐Luque ◽  
Miriam Cortés ◽  
Shirin E. Khorsandi ◽  
Maria D. Ayllón ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Meld Score

Low Preoperative Antithrombin III level is Associated with Postoperative Acute Kidney Injury after Liver Transplantation

2021 ◽  
Author(s):  
Kyoung-Sun Kim ◽  
Young-Jin Moon ◽  
Sung-Hoon Kim ◽  
In-Gu Jun ◽  
Hye-Mee Kwon ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Acute Kidney Injury ◽  
Animal Studies ◽  
Antithrombin Iii ◽  
Kidney Injury ◽  
High Body Mass Index ◽  
Deceased Donor ◽  
Meld Score ◽  
Red Blood Cell Transfusion ◽  
Duration Of Surgery

Abstract Background: The reno-protective effect of Antithrombin III (ATIII) has been well-studied in various animal studies; however, little is known about the effect of ATIII on kidney function in patients undergoing liver transplantation (LT). This study aimed to determine the association between preoperative ATIII level and postoperative acute kidney injury (AKI) after LT (post-LT AKI).Methods: We retrospectively evaluated 2,395 LT recipients between 2010 and 2018 whose data of perioperative ATIII levels were available. Patients were divided into two groups based on the preoperative level of ATIII (ATIII<50% vs. ATIII≥50%). Multivariable regression analysis was performed to assess the risk factors for post-LT AKI. In addition, subgroup analysis for the Model for End-stage liver disease (MELD) score (<20, ≥20) and donor types (deceased vs. living) were performed to identify the predictive value of ATIII.Results: The mean preoperative ATIII levels were 30.2±11.8% in the ATIII<50% group and 67.2±13.2% in the ATIII≥50% group. The incidence of post-LT AKI was significantly lower in ATIII≥50% group compared to that in the ATIII<50% group (54.7% vs. 75.5%, P<0.001; odds ratio [OR, per 10% increase of ATIII level] 0.86, 95% confidence interval [CI] 0.81–0.92; P<0.001). The prognostic value of ATIII was found to be statistically significant in the low-MELD group (<20, OR 0.82, 95% CI 0.77–0.87, P<0.001) and living donor LT (OR 0.89, CI 0.85–0.94, P<0.001) group. After a backward stepwise regression model, female sex, high body mass index, low albumin, deceased donor LT, longer duration of surgery, and high red blood cell transfusion remained significantly associated with post-LT AKI.Conclusion: Low preoperative ATIII level is associated with post-LT AKI, suggesting that preoperative ATIII might be a prognostic factor for predicting post-LT AKI.

scholarly journals Role of MELD Score and Serum Creatinine as Prognostic Tools for the Development of Acute Kidney Injury after Liver Transplantation

PLoS ONE ◽  
2013 ◽  
Vol 8 (5) ◽  
pp. e64089 ◽  
Author(s):  
Thiago Gomes Romano ◽  
Ivana Schmidtbauer ◽  
Fernanda Maria de Queiroz Silva ◽  
Carlos Eduardo Pompilio ◽  
Luiz Augusto Carneiro D'Albuquerque ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Kidney Injury ◽  
Meld Score

Postoperative acute kidney injury in living donor liver transplantation recipients

2017 ◽  
Vol 41 (1) ◽  
pp. 37-42 ◽  
Author(s):  
Hakan K. Atalan ◽  
Bulent Gucyetmez ◽  
Serdar Aslan ◽  
Serafettin Yazar ◽  
Kamil Y. Polat
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Acute Kidney Injury ◽  
Blood Loss ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Kidney Injury ◽  
Intraoperative Blood Loss ◽  
Donor Liver ◽  
Donor Liver Transplantation

Purpose: There are many risk factors for postoperative acute kidney injury in liver transplantation. The aim of this study is to investigate the risk factors for postoperative acute kidney injury in living donor liver transplantation recipients. Methods: 220 living donor liver transplantation recipients were retrospectively evaluated in the study. According to the Kidney Disease Improving Global Outcomes Guidelines, acute kidney injury in postoperative day 7 was investigated for all patients. The patient’s demographic data, preoperative and intraoperative parameters, and outcomes were recorded. Results: Acute kidney injury was found in 27 (12.3%) recipients. In recipients with acute kidney injury, female population, model for end-stage liver disease score, norepinephrine requirement, duration of mean arterial pressure less than 60 mmHg, the usage of gelatin and erythrocyte suspension and blood loss were significantly higher than recipients with nonacute kidney injury (for all p<0.05). In multivariate analyses, the likelihood of acute kidney injury on postoperative day 7 were increased 2.8-fold (1.1-7.0), 2.7-fold (1.02-7.3), 3.4-fold (1.2-9.9) and 5.1-fold (1.7-15.0) by postoperative day 7, serum tacrolimus level ≥10.2 ng dL−1, intraoperative blood loss ≥14.5 mL kg−1, the usage of gelatin >5 mL kg−1 and duration of MAP less than 60 mmHg ≥5.5 minutes respectively (for all p<0.05). Conclusions: In living donor liver transplantation recipients, serum tacrolimus levels, intraoperative blood loss, hypotension period and the usage of gelatin may be risk factors for acute kidney injury in the early postoperative period.

Propofol Attenuated Acute Kidney Injury after Orthotopic Liver Transplantation via Inhibiting Gap Junction Composed of Connexin 32

2015 ◽  
Vol 122 (1) ◽  
pp. 72-86 ◽  
Author(s):  
Chenfang Luo ◽  
Dongdong Yuan ◽  
Xiaoyun Li ◽  
Weifeng Yao ◽  
Gangjian Luo ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Liver Transplantation ◽  
Acute Kidney Injury ◽  
Gap Junction ◽  
Orthotopic Liver Transplantation ◽  
Critical Role ◽  
Kidney Injury ◽  
Cellular Injury ◽  
Knock Down ◽  
Hypoxia Reoxygenation

Abstract Background: Postliver transplantation acute kidney injury (AKI) severely affects patient survival, whereas the mechanism is unclear and effective therapy is lacking. The authors postulated that reperfusion induced enhancement of connexin32 (Cx32) gap junction plays a critical role in mediating postliver transplantation AKI and that pretreatment/precondition with the anesthetic propofol, known to inhibit gap junction, can confer effective protection. Methods: Male Sprague–Dawley rats underwent autologous orthotopic liver transplantation (AOLT) in the absence or presence of treatments with the selective Cx32 inhibitor, 2-aminoethoxydiphenyl borate or propofol (50 mg/kg) (n = 8 per group). Also, kidney tubular epithelial (NRK-52E) cells were subjected to hypoxia–reoxygenation and the function of Cx32 was manipulated by three distinct mechanisms: cell culture in different density; pretreatment with Cx32 inhibitors or enhancer; Cx32 gene knock-down (n = 4 to 5). Results: AOLT resulted in significant increases of renal Cx32 protein expression and gap junction, which were coincident with increases in oxidative stress and impairment in renal function and tissue injury as compared to sham group. Similarly, hypoxia–reoxygenation resulted in significant cellular injury manifested as reduced cell growth and increased lactate dehydrogenase release, which was significantly attenuated by Cx32 gene knock-down but exacerbated by Cx32 enhancement. Propofol inhibited Cx32 function and attenuated post-AOLT AKI. In NRK-52E cells, propofol reduced posthypoxic reactive oxygen species production and attenuated cellular injury, and the cellular protective effects of propofol were reinforced by Cx32 inhibition but cancelled by Cx32 enhancement. Conclusion: Cx32 plays a critical role in AOLT-induced AKI and that inhibition of Cx32 function may represent a new and major mechanism whereby propofol reduces oxidative stress and subsequently attenuates post-AOLT AKI.

Prognostic impact of early recovering acute kidney injury following liver transplantation

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Antoine Dewitte ◽  
Mylène Defaye ◽  
Anissa Dahmi ◽  
Alexandre Ouattara ◽  
Olivier Joannes-Boyau ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Prognostic Impact

MO398DETERIORATION OF RENAL OUTCOMES AND INCREASED MORTALITY RISK DUE TO ACUTE KIDNEY INJURY AFTER ORTHOTOPIC LIVER TRANSPLANTATION: SYSTEMATIC REVIEW AND META-ANALYSIS OF COHORT STUDIES

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Boby Pratama Putra ◽  
Felix Nugraha Putra
Keyword(s):  
Liver Transplantation ◽  
Acute Kidney Injury ◽  
Cohort Studies ◽  
Orthotopic Liver Transplantation ◽  
Mortality Risk ◽  
Random Effect ◽  
Kidney Injury ◽  
Cochrane Library ◽  
Ckd Progression ◽  
Renal Outcomes

Abstract Background and Aims Orthotopic liver transplantation (OLT) procedure is increased as incremental end-stage liver disease patients’ prevalence. Acute kidney injury (AKI) is one of most common post-OLT complications that is associated with poor renal outcomes and increased mortality risk although the results are still inconclusive. This study aims to measure the risk of deterioration of renal outcomes and mortality risk due to AKI incidence in post-OLT patients. Method We did comprehensive searching using predefined terms in online databases of Pubmed, EMBASE, ScienceDirect, and The Cochrane Library, to include all relevant studies from 2000-2020. We included all cohort studies that reported AKI incidence in post-OLT patients and accessed the risk of 3-month renal replacement therapy (RRT) need, 1-year chronic kidney disease (CKD) progression, and 1-year mortality rate. We used The Newcastle-Ottawa Scale for cohort study for accessing bias risk. We conducted analysis to pooled risk ratio (RR) with 95% confidence interval (CI) using random-effect heterogeneity test. Results We included 10 cohort studies met our inclusion criteria. The AKI incidence significantly both increases the need of RRT in post-OLT patients (pooled RR = 8.41. 95% CI = 2.82 to 25.09, p = 0.0001, I2 = 0%) then leads the CKD progression in one year (pooled RR = 6.76. 95% CI = 2.03 to 22.51, p = 0.002, I2 = 84%). The post-OLT patients who suffered from AKI has significant incremental 1-year mortality risk (pooled RR = 7.27. 95% CI = 4.34 to 12.18, p&lt;0.00001, I2 = 5%). Conclusion The incidence of AKI in post-OLT patients significantly increase the deterioration of renal outcomes and mortality risks. However, further trials are needed to establish the causalities.

scholarly journals Biomarkers of Renal Injury in Cirrhosis: Association with Acute Kidney Injury and Recovery after Liver Transplantation

Nephron ◽  
2017 ◽  
Vol 138 (1) ◽  
pp. 1-12 ◽  
Author(s):  
Ashwani K. Singal ◽  
Bradford Jackson ◽  
Glauber B. Pereira ◽  
Kirk B. Russ ◽  
Paul Stephen Fitzmorris ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Acute Kidney Injury ◽  
Renal Injury ◽  
Kidney Injury
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