Abstract
Acute renal injury (ARI) is a serious complication after liver transplantation. This study investigated the usefulness of the RIFLE criteria in living donor liver transplantation (LDLT) and the prognostic impact of ARI after LDLT. We analyzed 200 consecutive adult LDLT patients, categorized as risk (R), injury (I), or failure (F), according to the RIFLE criteria. ARI occurred in 60.5% of patients: R-class, 23.5%; I-class, 21%; and F-class, 16%. Four patients in Group-A (normal renal function and R-class) and 26 patients in Group-B (severe ARI: I- and F-class) required renal replacement therapy (P <0.001). Mild ARI did not affect postoperative prognosis regarding hospital mortality rate in Group A (3.2%), which was superior to that in Group B (15.8%; P = 0.0015). Fourteen patients in Group B developed chronic kidney disease (KDIGO stage 3/4). The 1-, 5- and 10-year survival rates were 96.7%, 90.6%, and 88.1% for Group A and 71.1%, 65.9%, and 59.3% for Group B, respectively (P <0.0001). Multivariate analysis revealed risk factors for severe ARI as MELD ≥20 [odds ratio (OR) 2.9], small-for-size graft (GW/RBW 55 ml/kg (OR 3.7), overexposure to calcineurin inhibitor (OR 2.5), and preoperative diabetes mellitus (OR 3.2). The RIFLE criteria offer a useful predictive tool after LDLT. Severe ARI, defined beyond class-I, could have negative prognostic impact in the acute and late postoperative phases. Perioperative treatment strategies should be designed and balanced based on the risk factors for the further improvement of transplant prognosis.
| Original language | English |
|---|---|
| Pages (from-to) | 842-852 |
| Number of pages | 11 |
| Journal | Transplant international : official journal of the European Society for Organ Transplantation |
| Volume | 26 |
| Issue number | 8 |
| DOIs | |
| Publication status | Published - Aug 2013 |
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Keywords
- acute renal failure
- liver transplantation
- living donor
- RIFLE criteria
ASJC Scopus subject areas
- Transplantation
Cite this
Risk factors for acute renal injury in living donor liver transplantation : Evaluation of the RIFLE criteria. / Utsumi, Masashi; Umeda, Yuzo; Sadamori, Hiroshi; Nagasaka, Takeshi; Takaki, Akinobu; Matsuda, Hiroaki; Shinoura, Susumu; Yoshida, Ryuichi; Nobuoka, Daisuke; Satoh, Daisuke; Fuji, Tomokazu; Yagi, Takahito; Fujiwara, Toshiyoshi.
In: Transplant international : official journal of the European Society for Organ Transplantation, Vol. 26, No. 8, 08.2013, p. 842-852.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Risk factors for acute renal injury in living donor liver transplantation
T2 - Evaluation of the RIFLE criteria
AU - Utsumi, Masashi
AU - Umeda, Yuzo
AU - Sadamori, Hiroshi
AU - Nagasaka, Takeshi
AU - Takaki, Akinobu
AU - Matsuda, Hiroaki
AU - Shinoura, Susumu
AU - Yoshida, Ryuichi
AU - Nobuoka, Daisuke
AU - Satoh, Daisuke
AU - Fuji, Tomokazu
AU - Yagi, Takahito
AU - Fujiwara, Toshiyoshi
PY - 2013/8
Y1 - 2013/8
N2 - Acute renal injury (ARI) is a serious complication after liver transplantation. This study investigated the usefulness of the RIFLE criteria in living donor liver transplantation (LDLT) and the prognostic impact of ARI after LDLT. We analyzed 200 consecutive adult LDLT patients, categorized as risk (R), injury (I), or failure (F), according to the RIFLE criteria. ARI occurred in 60.5% of patients: R-class, 23.5%; I-class, 21%; and F-class, 16%. Four patients in Group-A (normal renal function and R-class) and 26 patients in Group-B (severe ARI: I- and F-class) required renal replacement therapy (P <0.001). Mild ARI did not affect postoperative prognosis regarding hospital mortality rate in Group A (3.2%), which was superior to that in Group B (15.8%; P = 0.0015). Fourteen patients in Group B developed chronic kidney disease (KDIGO stage 3/4). The 1-, 5- and 10-year survival rates were 96.7%, 90.6%, and 88.1% for Group A and 71.1%, 65.9%, and 59.3% for Group B, respectively (P <0.0001). Multivariate analysis revealed risk factors for severe ARI as MELD ≥20 [odds ratio (OR) 2.9], small-for-size graft (GW/RBW 55 ml/kg (OR 3.7), overexposure to calcineurin inhibitor (OR 2.5), and preoperative diabetes mellitus (OR 3.2). The RIFLE criteria offer a useful predictive tool after LDLT. Severe ARI, defined beyond class-I, could have negative prognostic impact in the acute and late postoperative phases. Perioperative treatment strategies should be designed and balanced based on the risk factors for the further improvement of transplant prognosis.
AB - Acute renal injury (ARI) is a serious complication after liver transplantation. This study investigated the usefulness of the RIFLE criteria in living donor liver transplantation (LDLT) and the prognostic impact of ARI after LDLT. We analyzed 200 consecutive adult LDLT patients, categorized as risk (R), injury (I), or failure (F), according to the RIFLE criteria. ARI occurred in 60.5% of patients: R-class, 23.5%; I-class, 21%; and F-class, 16%. Four patients in Group-A (normal renal function and R-class) and 26 patients in Group-B (severe ARI: I- and F-class) required renal replacement therapy (P <0.001). Mild ARI did not affect postoperative prognosis regarding hospital mortality rate in Group A (3.2%), which was superior to that in Group B (15.8%; P = 0.0015). Fourteen patients in Group B developed chronic kidney disease (KDIGO stage 3/4). The 1-, 5- and 10-year survival rates were 96.7%, 90.6%, and 88.1% for Group A and 71.1%, 65.9%, and 59.3% for Group B, respectively (P <0.0001). Multivariate analysis revealed risk factors for severe ARI as MELD ≥20 [odds ratio (OR) 2.9], small-for-size graft (GW/RBW 55 ml/kg (OR 3.7), overexposure to calcineurin inhibitor (OR 2.5), and preoperative diabetes mellitus (OR 3.2). The RIFLE criteria offer a useful predictive tool after LDLT. Severe ARI, defined beyond class-I, could have negative prognostic impact in the acute and late postoperative phases. Perioperative treatment strategies should be designed and balanced based on the risk factors for the further improvement of transplant prognosis.
KW - acute renal failure
KW - liver transplantation
KW - living donor
KW - RIFLE criteria
UR - http://www.scopus.com/inward/record.url?scp=84880285916&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84880285916&partnerID=8YFLogxK
U2 - 10.1111/tri.12138
DO - 10.1111/tri.12138
M3 - Article
VL - 26
SP - 842
EP - 852
JO - Transplant International
JF - Transplant International
SN - 0934-0874
IS - 8
ER -