Abstract
Acute renal failure (ARF) often complicates the postoperative period of patients undergoing orthotopic liver transplantation (OLT); it is habitually associated with high mortality rates. Similarly, patients undergoing major nonelective abdominal surgery are prone to ARF because of their frequent preexistent morbidities, abdominal sepsis, and needed for extended surgical procedures. The aim of this study was to evaluate the incidence of ARF and use of renal replacement therapy (RRT) among OLT versus nonelective abdominal surgery patients and associations with clinical outcomes. We studied all the patients admitted to a surgical intensive care unit (ICU) from January 2008 to December 2009 after OLT or nonelective abdominal surgery. The inclusion criteria were an ICU stay of at least 48 hours and without prior end-stage renal failure. OLT patients ( n = 84) were younger and less severly ill than surgery patients ( n = 60). ARF occurrence was lower among the OLT (29%) than the surgery group (47%) requiring RRT in 71% and 53% of patients due to ARF, respectively. The ICU mortality of ARF patients in both groups (29% OLT and 51% surgery) were greater than among subjects without ARF (2% and 6%). The occurrence of ARF is common among these two patient groups, and associated with increased risk of death among in surgery (+45%) versus in OLT (+27%) patients.
Highlights
ACUTE RENAL FAILURE (ARF) is frequently observed in the postoperative period of patients undergoing orthotopic liver transplantation (OLT); reported incidences range from 12% to 70%.1 The development of ARF is closed related to medical and surgical complications
We studied 84 patients undergoing OLT and 60 admitted to intensive care unit (ICU) after emergency abdominal surgery
The requirement for renal replacement therapy (RRT) increased in significantly the ICU and hospital mortality among ARF patients in both groups (Table 1). This retrospective analysis indicated that during the postoperative period the occurrence of ARF was common among OLT patients (1/3 of patients), but it was more common among subjects admitted to the ICU after nonelective major abdominal surgery (1/2 patients)
Summary
ACUTE RENAL FAILURE (ARF) is frequently observed in the postoperative period of patients undergoing orthotopic liver transplantation (OLT); reported incidences range from 12% to 70%.1 The development of ARF is closed related to medical and surgical complications. The mortality rate of OLT patients undergoing renal replacement therapy (RRT) may reach 90%.2. A history of hepatorenal syndrome, massive intraoperative transfusions, long graft ischemia, and the use of nephrotoxic immunosuppressant agents and antibiotics seem to be the major causative factors involved in ARF appearance after OLT.[1,2,3,4]. As in OLT, renal dysfunction in patients undergoing emergency abdominal surgery is commonly associated with a high morbidity and mortality. It is generally related to hypoxic damage caused by systemic hypotension or reduced renal perfusion due to intra-abdominal hypertension. The preexisting risks factors, like mild to moderate renal dysfunction, diabetes mellitus, patient age over 65 years, and recent exposure to nephrotoxic drugs, are important be considerations in the strat-
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