Abstract
Acute kidney injury (AKI) is a frequent complication after living donor liver transplantation (LDLT), and is associated with increased mortality. However, the association between intraoperative oliguria and the risk of AKI remains uncertain for LDLT. We sought to determine the association between intraoperative oliguria alone and oliguria coupled with hemodynamic derangement and the risk of AKI after LDLT. We evaluated the hemodynamic variables, including mean arterial pressure, cardiac index, and mixed venous oxygen saturation (SvO2). We reviewed 583 adult patients without baseline renal dysfunction and who did not receive hydroxyethyl starch during surgery. AKI was defined using the Kidney Disease Improving Global Outcomes criteria according to the serum creatinine criteria. Multivariable logistic regression analysis was performed with and without oliguria and oliguria coupled with a decrease in SvO2. The performance was compared with respect to the area under the receiver operating characteristic curve (AUC). Intraoperative oliguria <0.5 and <0.3 mL/kg/h were significantly associated with the risk of AKI; however, their performance in predicting AKI was poor. The AUC of single predictors increased significantly when oliguria was combined with decreased SvO2 (AUC 0.72; 95% confidence interval (CI) 0.68–0.75 vs. AUC of oliguria alone 0.61; 95% CI 0.56–0.61; p < 0.0001; vs. AUC of SvO2 alone 0.66; 95% CI 0.61–0.70; p < 0.0001). Addition of oliguria coupled with SvO2 reduction also increased the AUC of multivariable prediction (AUC 0.87; 95% CI 0.84–0.90 vs. AUC with oliguria 0.73; 95% CI 0.69–0.77; p < 0.0001; vs. AUC with neither oliguria nor SvO2 reduction 0.68; 95% CI 0.64–0.72; p < 0.0001). Intraoperative oliguria coupled with a decrease in SvO2 may suggest the risk of AKI after LDLT more reliably than oliguria alone or decrease in SvO2 alone. Intraoperative oliguria should be interpreted in conjunction with SvO2 to predict AKI in patients with normal preoperative renal function and who did not receive hydroxyethyl starch during surgery.
Highlights
The incidence of acute kidney injury (AKI) after orthotopic liver transplantation has been reported to be as high as 64% [1,2,3,4]
In the present study, we aimed to investigate the specific impact of intraoperative oliguria on the risk of AKI after living donor liver transplantation (LDLT) determined by KDIGO criteria
These results suggested that oliguria by a reduction in SvO2 during LDLT may be more strongly associated with the development of AKI
Summary
The incidence of acute kidney injury (AKI) after orthotopic liver transplantation has been reported to be as high as 64% [1,2,3,4]. AKI is an important complication associated with poor graft survival and increased mortality [1,2,5,6,7,8]. Post-transplant AKI is associated with the development of chronic kidney disease [3,9,10]. Diagnosis of AKI is based on elevation of serum creatinine and/or decrease in urine output in the currently available KDIGO (Kidney Disease Improving Global Outcomes) criteria [7,11].
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