Abstract
For ABO-incompatible liver transplantation (ABO-i LT), therapeutic plasma exchange (TPE) is performed preoperatively to reduce the isoagglutinin titer of anti-ABO blood type antibodies. We evaluated whether perioperative high isoagglutinin titer is associated with postoperative risk of acute kidney injury (AKI). In 130 cases of ABO-i LT, we collected immunoglobulin (Ig) G and Ig M isoagglutinin titers of baseline, pre-LT, and postoperative peak values. These values were compared between the patients with and without postoperative AKI. Multivariable logistic regression analysis was used to evaluate the association between perioperative isoagglutinin titers and postoperative AKI. Clinical and graft-related outcomes were compared between high and low baseline and postoperative peak isoagglutinin groups. The incidence of AKI was 42.3%. Preoperative baseline and postoperative peak isoagglutinin titers of both Ig M and Ig G were significantly higher in the patients with AKI than those without AKI. Multivariable logistic regression analysis showed that preoperative baseline and postoperative peak Ig M isoagglutinin titers were significantly associated with the risk of AKI (baseline: odds ratio 1.06, 95% confidence interval 1.02 to 1.09; postoperative peak: odds ratio 1.08, 95% confidence interval 1.04 to 1.13). Cubic spline function curves show a positive relationship between the baseline and postoperative peak isoagglutinin titers and the risk of AKI. Clinical outcomes other than AKI were not significantly different according to the baseline and postoperative peak isoagglutinin titers. Preoperative high initial and postoperative peak Ig M isoagglutinin titers were significantly associated with the development of AKI. As the causal relationship between high isoagglutinin titers and risk of AKI is unclear, the high baseline and postoperative isoagglutinin titers could be used simply as a warning sign for the risk of AKI after liver transplantation.
Highlights
Introductionacute kidney injury (AKI) is regarded to be clinically important because it is associated with poor graft survival, the development of chronic kidney disease [12,13], and increased mortality [3,4,7,14,15]
Patient demographics and characteristics were compared between patients with high and low initial baseline Ig M isoagglutinin titers (Table 1)
The perioperative transfusion amount was significantly higher in the high isoagglutinin titer group, and the incidence of early allograft dysfunction tended to be higher in the high isoagglutinin titer group
Summary
AKI is regarded to be clinically important because it is associated with poor graft survival, the development of chronic kidney disease [12,13], and increased mortality [3,4,7,14,15]. In this era of donor organ shortage for end-stage liver disease, ABO-incompatible liver transplantation (ABO-i LT) is a good therapeutic choice [16]. The incidence of AKI after ABO-i LT has still been reported to be higher than ABO-compatible LT [9]
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