Abstract

Background: Patients following liver transplantation are at risk to develop acute kidney injury (AKI). The aim of our study was to assess risk factors for the development of AKI and the impact of AKI on the outcome of patients after liver transplantation (OLT).Patients and methods: In this retrospective study, we analyzed 149 patients undergoing OLT from 1/2004 to 12/2007. AKI was defined according to the KDIGO definition representing the AKIN and the RIFLE classification, and according to the need for renal replacement therapy (RRT).Results: According to the AKIN criteria alone 14 patients, according to the RIFLE criteria alone no patient and according to both definitions 30 patients developed AKI. RRT was required in 54 patients experiencing AKI, whereas 51 patients did not develop AKI. Pre OLT serum creatinine (SCr) significantly predicted the development of AKI requiring RRT, but not AKI without RRT requirement. Survival rate was significantly inferior after 28 days, one or three years in patients with AKI requiring RRT (70.4, 46.4, 44.4% vs. 100, 92.2, 90.2%, P < 0.001). There was no difference in survival between patients experiencing AKI according to the RIFLE or AKIN criteria without RRT requirement and patients without AKI.Conclusion: Pre OLT renal dysfunction assessed by SCr was the most important risk factor predicting severe forms of AKI, but not milder forms of AKI. AKI requiring RRT had a detrimental impact on patients’ survival, whereas milder forms of AKI were not associated with a worse outcome.

Highlights

  • Patients following orthotopic liver transplantation (OLT) are at major risk to develop acute kidney injury (AKI) [1,2,3,4]

  • On the basis of glomerula filtration rate, serum-creatinine (SCr), and urine output the Acute Dialysis Qualitative Initiative (ADQI) group defined five categories for renal damage. This definition was refined by the Acute Kidney Injury Network (AKIN) group [8] focusing on immediate changes in serum creatinine and urine output

  • We evaluate the impact of AKI, defined by kidney disease improving global outcome (KDIGO) representing the RIFLE and the AKIN definition, and the impact of AKI requiring renal replacement therapy (RRT) in patients after liver transplantation

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Summary

Introduction

Patients following orthotopic liver transplantation (OLT) are at major risk to develop acute kidney injury (AKI) [1,2,3,4]. This heterogeneity of definitions limited comparisons of risk factors and outcomes across study populations To overcome these flaws, in 2004 the Acute Dialysis Qualitative Initiative (ADQI) group [11] established a general definition of AKI, called the RIFLE criteria. On the basis of glomerula filtration rate, serum-creatinine (SCr), and urine output the ADQI group defined five categories for renal damage This definition was refined by the Acute Kidney Injury Network (AKIN) group [8] focusing on immediate changes in serum creatinine and urine output. The aim of our study was to assess risk factors for the development of AKI and the impact of AKI on the outcome of patients after liver transplantation (OLT). AKI requiring RRT had a detrimental impact on patients’ survival, whereas milder forms of AKI were not associated with a worse outcome

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