Late-Onset Hepatic Failure in Children: Risk Factors that Determine the Outcome

2020 ◽  
Vol 38 (5) ◽  
pp. 415-420
Author(s):  
Sumit Kumar Singh ◽  
Moinak Sen Sarma ◽  
Surender Kumar Yachha ◽  
Anshu Srivastava ◽  
Ujjal Poddar
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Acute Kidney Injury ◽  
Liver Disease ◽  
Hepatic Failure ◽  
Late Onset ◽  
Univariate Analysis ◽  
Kidney Injury ◽  
Native Liver ◽  
Late Onset Hepatic Failure

Background: Late-onset hepatic failure (LOHF) is a distinct entity of intractable liver diseases with limited pediatric experience. We aimed to identify the etiology and risk factors that determine the poor outcome (PO) of pediatric LOHF. Methods: LOHF was defined as liver failure occurring 5–24 weeks after onset of jaundice and without any evidence of underlying chronic liver disease. PO (death or liver transplantation within 160 days) was compared with spontaneous recovery (SR; complete normalization of liver functions in the native liver). Pediatric end-stage liver disease (PELD) score and King’s College Criteria (KCC) were applied to investigate their prognostic value. Results: We enrolled 47 children (6 [2–16] years) with LOHF. Hepatitis A was the most common etiology (15, 32%) and 64% complicated with infections. Twelve children (25%) had SR over 6 (1–24) months, while 28 (60%) children had PO. Univariate analysis showed indeterminate etiology, hepatic encephalopathy (HE), infection, acute kidney injury, and high PELD score determined PO. On multivariate regression analysis, only PELD score with a cutoff 32 (area under curve 0.833, sensitivity 68%, specificity 92%) predicted PO. KCC showed a sensitivity of 85.7%, specificity of 41.7% to determine PO in our cohort. Conclusion: Indeterminate etiology, presence of HE, occurrence of infection at any site, and acute kidney injury lead to the PO. PELD score ≥32 can be utilized to optimize the listing for liver transplantation. A significant proportion survives with the native liver.

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.

Liver transplantation for fulminant hepatic failure and late-onset hepatic failure in children

1992 ◽  
Vol 79 (11) ◽  
pp. 1192-1194 ◽  
Author(s):  
K. C. Tan ◽  
R. S. Mondragon ◽  
V. Vougas ◽  
G. Mieli-Vergani ◽  
N. D. Heaton ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Fulminant Hepatic Failure ◽  
Hepatic Failure ◽  
Late Onset ◽  
Late Onset Hepatic Failure

scholarly journals Risk factors for acute kidney injury and 30-day mortality after liver transplantation

2015 ◽  
Vol 14 (5) ◽  
pp. 688-694 ◽  
Author(s):  
Adller G.C. Barreto ◽  
Elizabeth F. Daher ◽  
Geraldo B. Silva Junior ◽  
José Huygens P. Garcia ◽  
Clarissa B.A. Magalhães ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Acute Kidney Injury ◽  
Kidney Injury

Risk factors for acute kidney injury after orthotopic liver transplantation: A single-center data analysis

2017 ◽  
Vol 37 (6) ◽  
pp. 861-863 ◽  
Author(s):  
Zhi-qiang Zhou ◽  
Long-chang Fan ◽  
Xu Zhao ◽  
Wei Xia ◽  
Ai-lin Luo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Acute Kidney Injury ◽  
Data Analysis ◽  
Orthotopic Liver Transplantation ◽  
Kidney Injury ◽  
Single Center

scholarly journals PREOPERATIVE RISK FACTORS FOR ACUTE KIDNEY INJURY AFTER LIVER TRANSPLANTATION: RESULTS FROM A CROSS-SECTIONAL STUDY IN NORTHEAST OF BRAZIL

2018 ◽  
Vol 55 (1) ◽  
pp. 18-22 ◽  
Author(s):  
Raimundo Martins GOMES JUNIOR ◽  
Lia Cavalcante CEZAR ◽  
Gdayllon Cavalcante MENESES ◽  
Geraldo Bezerra da SILVA JUNIOR ◽  
José Huygenes Parente GARCIA ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Acute Kidney Injury ◽  
Serum Albumin ◽  
Kidney Injury ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Preoperative Risk ◽  
Cross Sectional ◽  
Preoperative Risk Factors

ABSTRACT BACKGROUND: Acute kidney injury (AKI) is a common complication in the immediate postoperative period of patients undergoing liver transplantation. OBJECTIVE: The aim of this study was to evaluate preoperative risk factors for AKI after liver transplantation. METHODS: A cross-sectional study was conducted with adults submitted to orthotopic liver transplantation at a reference hospital in Fortaleza, Northeast of Brazil, from January to December 2016. Preoperative risk factors were evaluated for AKI development in the immediate postoperative period. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. RESULTS: A total of 40 patients were included in the study. AKI was found in 85% of patients in the first 24 hours after transplantation, most of them (40%) classified in KDIGO stage 1. Preoperative data indicate that serum albumin levels were lower in the KDIGO stage 3 group compared to the non-AKI group, as well as the hematocrit levels. Direct bilirubin (DB) was higher in the KDIGO stage 3 group compared to the group without AKI, as well as alkaline phosphatase (AP) and gamma-glutamiltransferase (GGT). In a logistic regression analysis independent risk factors for AKI were increase levels of AP, GGT and DB and decrease level of serum albumin. CONCLUSION: Low levels of serum albumin, and elevated levels of DB, AP and GGT in the preoperative period are risk factors for AKI development after liver transplantation.

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