Risk factors for postoperative acute renal failure at a new orthotopic liver transplantation program

Abstract

ACUTE RENAL failure (ARF) is a frequently observed complication during the postoperative period of orthotopic liver transplantation (OLT) when the rate of reported renal failure varies according to the postoperative period and serum creatinine levels considered. Although some patients require dialysis, most recover normal renal function. ARF is one of the most frequent causes of morbidity and mortality after OLT, and Nuno et al indicate a 7.8 higher probability of mortality in patients who have undergone ARF, and 15 times higher than that for those patients who required dialysis. Various factors are outstanding in the preoperative and postoperative periods, as well as during surgery, which could explain the occurrence of ARF. Preoperative factors include: diabetes mellitus, a history of ascites and encephalopathy, and previous kidney lesion. Crawford et al described the occurrence of glomerular lesions as universal to all patients with end-stage liver disease. During surgery, hypovolemia, the number of packed red blood cell (PRBC) units required and the time of total ischemia are described as associated factors. Several series correlate the use of nephrotoxic drugs, such as cyclosporine A (CyA), as a factor which could contribute to renal lesions. However, this may also be the result of complications such as sepsis and multiorgan failure. The purpose of this study is to assess the factors associated with the development of renal failure during the immediate postoperative period of an initial OLT program.