Risk factors for acute renal injury in living donor liver transplantation

Evaluation of the RIFLE criteria

Masashi Utsumi, Yuzo Umeda, Hiroshi Sadamori, Takeshi Nagasaka, Akinobu Takaki, Hiroaki Matsuda, Susumu Shinoura, Ryuichi Yoshida, Daisuke Nobuoka, Daisuke Satoh, Tomokazu Fuji, Takahito Yagi, Toshiyoshi Fujiwara

Research output: Contribution to journalArticle

42 Citations (Scopus)

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 languageEnglish
Pages (from-to)842-852
Number of pages11
JournalTransplant international : official journal of the European Society for Organ Transplantation
Volume26
Issue number8
DOIs
Publication statusPublished - Aug 2013

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Living Donors
Acute Kidney Injury
Liver Transplantation
Odds Ratio
Transplants
Renal Replacement Therapy
Hospital Mortality
Chronic Renal Insufficiency
Diabetes Mellitus
Multivariate Analysis
Survival Rate
Kidney
Mortality
Wounds and Injuries

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 journalArticle

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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.",
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AU - Takaki, Akinobu

AU - Matsuda, Hiroaki

AU - Shinoura, Susumu

AU - Yoshida, Ryuichi

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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.

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