Acute renal failure after cadaveric related liver transplantation

Abstract

Acute renal failure (ARF) is a frequent medical complication after liver transplantation (LT). We analyzed cadaveric related liver transplant recipients who had developed ARF early in the postoperative course. Between January 1982 and August 2003, a total of 67 patients underwent cadaveric related LT. Their mean age was 28.64 years at LT. The 67 recipients had the following indications: biliary atresia ( n = 17), Wilson's disease ( n = 15), hepatitis B–related liver cirrhosis ( n = 14), hepatitis C–related liver cirrhosis ( n = 4), primary biliary cirrhosis ( n = 4), hepatitis B–related liver cirrhosis with hepatoma ( n = 3), hepatitis C–related liver cirrhosis with hepatoma ( n = 2), Budd-Chiari syndrome ( n = 2), neonatal hepatitis ( n = 1), choledochus cyst ( n = 1), autoimmune cirrhosis ( n = 1), neuroendocrine tumor ( n = 1), and hemangioendothelioma ( n = 1). Forty-nine patients received cyclosporine (CsA), azathioprine, and steroids and 18, a combination with tacrolimus (FK506). Eight (11.94%) patients developed ARF at a mean time of 17.25 days after LT. The mean peak serum creatinine was 2.24 mg%. Four of these patients had a diagnosis of hepatitis B–related liver cirrhosis; two, hepatitis C–related liver cirrhosis; one, primary biliary cirrhosis; and one, hepatitis B–related liver cirrhosis with hepatoma. The ARF etiology was multifactorial for the majority of patients. Eight ARF patients had a history of liver cirrhosis, which may be a risk factor for intraoperative ARF. ARF treatment included fluid replacement, decreased or altered immunosuppressive agents, avoiding exposure to nephrotoxic drugs, and adjusting antibiotic dosages. The majority of patients returned to normal renal function at 1 to 3 weeks after the diagnosis of ARF. No patient required dialysis and/or experienced a mortality. We conclude that the incidence of ARF is relatively low and with good outcomes. ARF etiology was multifactorial for the majority of patients, but eight patients had a history of liver cirrhosis, which may be a risk factor for intraoperative ARF. We suggest that in the early postoperative period of LT cases diagnosis and treatment of ARF are important.