Abstract
Purpose Acute kidney injury (AKI) is a major and severe complication following donation-after-circulatory-death (DCD) liver transplantation (LT) and is associated with increased postoperative morbidity and mortality. However, the risk factors and the prognosis factors of AKI still need to be further explored, and the relativity of intraoperative hepatic blood inflow (HBI) and AKI following LT has not been discussed yet. The purpose of this study was to investigate the correlation between HBI and AKI and to construct a prediction model of early acute kidney injury (EAKI) following DCD LT with the combination of HBI and other clinical parameters. Methods Clinical data of 132 patients who underwent DCD liver transplantation at the first hospital of China Medical University from April 2005 to March 2017 were analyzed. Data of 105 patients (the first ten years of patients) were used to develop the prediction model. Then we assessed the clinical usefulness of the prediction models in the validation cohort (27 patients). EAKI according to Kidney Disease Improving Global Outcomes (KDIGO) criteria based on serum creatinine increase during 7-day of postoperative follow-up. Results After Least Absolute Shrinkage and Selection Operator (LASSO) regression and simplification, a simplified prediction model consisting of the Child-Turcotte-Pugh (CTP) score (p=0.033), anhepatic phase (p=0.014), packed red blood cell (pRBC) transfusion (p=0.027), and the HBI indexed by height (HBI/h) (p=0.002) was established. The C-indexes of the model in the development and validation cohort were 0.823 [95% CI, 0.738-0.908] and 0.921 [95% CI, 0.816-1.000], respectively. Conclusions In this study, we demonstrated the utility of HBI/h as a predictor for EAKI following DCD LT, as well as the clinical usefulness of the prediction model through the combination of the CTP score, anhepatic phase, pRBC transfusion and HBI/h.
Highlights
Acute kidney injury (AKI) is a major and severe complication following orthotopic liver transplantation and is associated with poor graft survival and increased mortality [1, 2]
To predict the occurrence of AKI after LT and treat AKI as early as possible will significantly improve the outcome of liver transplantation
early acute kidney injury (EAKI) occurred in 31 patients (29.5%) in the development cohort
Summary
Acute kidney injury (AKI) is a major and severe complication following orthotopic liver transplantation and is associated with poor graft survival and increased mortality [1, 2]. The incidence of AKI after liver transplantation (LT) is high and ranges from 20 to 64% [1, 3,4,5,6,7,8]. Most of the studies reported risk factors of AKI after LT including longer anhepatic phase [13], larger red blood cell (RBC) transfusion amount [5, 14], and higher Child-Turcotte-Pugh (CTP) score [15]. Some hemodynamic factors such as BioMed Research International intraoperative mean arterial blood pressure [16], the use of intraoperative venovenous bypass technology [17], central venous pressure, right ventricular end-diastolic volume, and mixed venous oxygen saturation [6] have been reported to significantly influence the occurrence of postoperative AKI. Hypertension, n Diabetes mellitus, n Smoking, n Alcoholic liver cirrhosis, n HBV hepatitis, n HCV hepatitis, n Liver tumor, n Cholestatic disease, n Hepatic encephalopathy, n Serum albumin level, g/L Total bilirubin, μmol/L Prothrombin time, s MELD score CTP score Child class, n (A/ B/ C)
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