Early Kidney Dysfunction after Liver Transplantation. Analysis of the Factors Involved in its Appearance and its Limpact on the Evolution of Patients

Abstract

Purpose: Post-liver transplantation acute renal dysfunction is a poorly studied issue. We provide the results of an analysis, focused on identifying factors favoring its appearance, and analyzing the real impact of its development on the evolution of patients. Method: Observational single-center study carried out in a Spanish Liver Transplant Unit on a cohort of patients undergoing orthotopic liver transplantation from a cadaveric donor between May 2011 and October 2018. The presence of acute renal dysfunction (RIFLE criteria) was considered as a decrease in glomerular filtration rate (GFR) greater than 50% 48 hours after transplantation compared to the GFR immediately before transplantation. Results: Of 237 transplants performed, 172 met the inclusion criteria. They were mostly male patients (78%), with a median age and biological MELD score of 54 years and 15 points, respectively, and a prevalence of diabetes mellitus and arterial hypertension of 31 and 25%, respectively. The incidence of acute renal dysfunction was 29.7%, and the independent predictive factors for its development were pre-transplant arterial hypertension (Odds Ratio (OR) of 2.7), and pre-transplant deterioration of the recipient's liver function (OR 4,1). The development of acute renal dysfunction favors the appearance of early liver graft dysfunction according to the Olthoff et al criteria (p = 0.005). Although the survival at 3 and 6 months of the patient decreases (93.4 and 89.7% vs. 80 and 75%, respectively), and graft (90.9 and 87.9% vs. 80 and 75%, respectively), it does not alter the long-term survival of either of the two (p = 0.109 and 0.72, respectively). Conclusion: The factors that favor the appearance of early acute renal dysfunction after liver transplantation are arterial hypertension and the deterioration of liver function. Its establishment favors the development of early liver graft dysfunction and worsens patient and graft survival in the short and medium term, although it does not affect the long-term survival of both or kidney function.