Liver Transplant Patients with High Levels of Preoperative Serum Ammonia Are at Increased Risk for Postoperative Acute Kidney Injury: A Retrospective Study.

Yoon Sook Lee,Kyu Hee Park,Yoon Ji Choi,Je Ho Ryu,Byeong Seon Park,Hyun-Su Ri,Jung-Min Son,Ju Yeon Park

doi:10.3390/jcm9061629

Abstract

Acute kidney injury (AKI) is one of the most frequent postoperative complications after liver transplantation (LT). Increased serum ammonia levels due to the liver disease itself may affect postoperative renal function. This study aimed to compare the incidence of postoperative AKI according to preoperative serum ammonia levels in patients after LT. Medical records from 436 patients who underwent LT from January 2010 to February 2020 in a single university hospital were retrospectively reviewed. The patients were then categorized according to changes in plasma creatinine concentrations within 48 h of LT using the Acute Kidney Injury Network criteria. A preoperative serum ammonia level above 45 mg/dL was associated with postoperative AKI (p < 0.0001). Even in patients with a normal preoperative creatinine level, when the ammonia level was greater than 45 μg/dL, the incidence of postoperative AKI was significantly higher (p < 0.0001); the AKI stage was also higher in this group than in the group with preoperative ammonia levels less than or equal to 45 μg/dL (p < 0.0001). Based on the results of our research, an elevation in preoperative serum ammonia levels above 45 μg/dL is related to postoperative AKI after LT.

Highlights

The causes of postoperative acute kidney injury (AKI) after liver transplantation (LT) are multifactorial and include the status of the recipient and pre- and post-operative risk factors [1]
The model for the end-stage liver disease scores was higher in patients in Group AKI than those in Group C (p < 0.001)
A preoperative serum ammonia level above 45 μg/dL was correlated with postoperative AKI after LT in this retrospective analysis of LT recipients

Summary

Introduction

The causes of postoperative acute kidney injury (AKI) after liver transplantation (LT) are multifactorial and include the status of the recipient and pre- and post-operative risk factors [1]. Postoperative AKI can potentially progress to a requirement for post-transplant kidney replacement therapy [6], to chronic kidney disease, and/or progress to end-stage renal disease [4,7]. 18.1% of patients showed progression to chronic kidney disease after LT, and 4.8% of patients showed progression to end-stage renal disease within 5 years [8,9]. Pre-operative renal dysfunction often affects the degree of liver dysfunction and significantly affects the development of postoperative AKI [10,11]. Elevation of serum ammonia levels, which occurs during liver disease, may affect kidney function

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