Acute Kidney Injury after ALPPS Procedure (Case Report)

Abstract

Acute kidney injury (AKI) is a serious complication after major liver resection. It may be caused by post-hepatectomy liver failure (PLF). ALPPS (Associating Liver Partition and Portal Vein Ligation for Staged hepatectomy) procedure is an effective way for PLF prevention in cases of small future remnant volume or bilobar liver lesions, but the risk of AKI following this procedure is unknown. Herein we present and discuss the case of a 23-year-old man with hepatic alveococcosis who underwent ALPPS procedure. Despite absence of any risk factors AKI (RIFLE-F) followed by renal replacement therapy (RRT) has occurred within few hours after the first surgical stage. Only the combination of albumin and terlipressin resulted function improvement and RRT with drawal after three weeks of AKI onset. Renal dysfunction didn’t affect the liver regeneration and the second stage of ALPPS has been performed in six days after the first one. There were no signs of serious liver synthetic function deterioration, coagulopathy, jaundice or encephalo pathy. The mechanisms of AKI progression as well as the portal and systemic circulatorychanges after the first stage of ALPPS seem to be similar with hepatorenal syndrome type I. Intra- and postoperative maintenance of physiologic hemodynamics may be the key point for AKI prevention. Norepinephrine and/or terlipressin could be considered as the drugs of choice.