Xiaohong Chen1,2,3,4, Xiaoqiang Ding5,6,7,8, Bo Shen1,2,3,4, Jie Teng1,2,3,4, Jianzhou Zou1,2,3,4, Ting Wang9, Jian Zhou9, Nan Chen10, Boheng Zhang11. 1. Blood Purification Center, Zhongshan Hospital of Fudan University, Shanghai, 200032, People's Republic of China. 2. Department of Nephrology, Zhongshan Hospital of Fudan University, Shanghai, 200032, People's Republic of China. 3. Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, 200032, People's Republic of China. 4. Shanghai Institute of Kidney and Dialysis, Shanghai, 200032, People's Republic of China. 5. Blood Purification Center, Zhongshan Hospital of Fudan University, Shanghai, 200032, People's Republic of China. ding.xiaoqiang@zs-hospital.sh.cn. 6. Department of Nephrology, Zhongshan Hospital of Fudan University, Shanghai, 200032, People's Republic of China. ding.xiaoqiang@zs-hospital.sh.cn. 7. Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, 200032, People's Republic of China. ding.xiaoqiang@zs-hospital.sh.cn. 8. Shanghai Institute of Kidney and Dialysis, Shanghai, 200032, People's Republic of China. ding.xiaoqiang@zs-hospital.sh.cn. 9. Department of Liver Surgery, Zhongshan Hospital of Fudan University, Shanghai, 200032, People's Republic of China. 10. Intensive Care Unit, Shanghai Public Health Clinical Center, Zhongshan Hospital of Fudan University, Shanghai, 200032, People's Republic of China. 11. Liver Cancer Institute, Shanghai, 200032, People's Republic of China.
Abstract
PURPOSE: To describe the incidence and outcomes linked with acute kidney injury (AKI) after liver transplantation (LT) in hepatocellular carcinoma (HCC) patients. METHODS: From January 2003 to February 2011, HCC patients undergoing LT were retrospectively enrolled. Patient with a glomerular filtration rate (GFR) <60 mL/min/1.73 m2 was excluded. AKI was defined and classified according to the AKIN criteria. RESULTS: Of the 566 eligible patients, AKI was found in 109 (19.26%) patients (stage I, 66 cases; stage II, 15 cases; and stage III, 28 cases). Risk factors for AKI were the long anhepatic time (OR = 3.59, P = 0.009) and prolonged duration of systolic blood pressure (SBP) < 90 mmHg (OR = 1.07, P < 0.0001). Post-LT AKI was an independent risk factor associated with 30-day mortality (HR = 4.05, P = 0.047). Complete recovery occurred in 84 (77.06%) of all AKI episodes within 1 month after operation, while 25 patients (22.94%) suffered from prolonged AKI. Patients with prolonged AKI had a poorer 1-year survival than those with transient AKI (40 vs 86.90%; P < 0.0001). Patients with severe AKI more often developed prolonged AKI. 13 patients (52%) of the prolonged AKI progressed to chronic kidney disease (CKD) defined as eGFR <60 mL/min/1.73 m2 after 1 year post-operation. CONCLUSIONS: Post-LT AKI is not an uncommon complication. Intra-operative hemodynamic instability is crucial in the development of post-LT AKI and deserves more attention. Most post-LT AKI is transient and reversible, while the prolonged form may predict a decrease survival.
PURPOSE: To describe the incidence and outcomes linked with acute kidney injury (AKI) after liver transplantation (LT) in hepatocellular carcinoma (HCC) patients. METHODS: From January 2003 to February 2011, HCCpatients undergoing LT were retrospectively enrolled. Patient with a glomerular filtration rate (GFR) <60 mL/min/1.73 m2 was excluded. AKI was defined and classified according to the AKIN criteria. RESULTS: Of the 566 eligible patients, AKI was found in 109 (19.26%) patients (stage I, 66 cases; stage II, 15 cases; and stage III, 28 cases). Risk factors for AKI were the long anhepatic time (OR = 3.59, P = 0.009) and prolonged duration of systolic blood pressure (SBP) < 90 mmHg (OR = 1.07, P < 0.0001). Post-LT AKI was an independent risk factor associated with 30-day mortality (HR = 4.05, P = 0.047). Complete recovery occurred in 84 (77.06%) of all AKI episodes within 1 month after operation, while 25 patients (22.94%) suffered from prolonged AKI. Patients with prolonged AKI had a poorer 1-year survival than those with transient AKI (40 vs 86.90%; P < 0.0001). Patients with severe AKI more often developed prolonged AKI. 13 patients (52%) of the prolonged AKI progressed to chronic kidney disease (CKD) defined as eGFR <60 mL/min/1.73 m2 after 1 year post-operation. CONCLUSIONS: Post-LT AKI is not an uncommon complication. Intra-operative hemodynamic instability is crucial in the development of post-LT AKI and deserves more attention. Most post-LT AKI is transient and reversible, while the prolonged form may predict a decrease survival.
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