Minerva Anestesiologica 2022 April;88(4):248-58

DOI: 10.23736/S0375-9393.21.15860-2

language: English

Acute kidney injury after liver transplantation, perioperative risk factors, and outcome: prospective observational study of 1681 patients (OLTx Study)

Silvia FIORELLI ¹ ✉, Giandomenico BIANCOFIORE ², Paolo FELTRACCO ³, Bruna LAVEZZO ⁴, Andrea DE GASPERI ⁵, Livia POMPEI ⁶, Lucia MASIERO ⁷, Silvia TESTA ⁷, Andrea RICCI ⁷, Giorgio DELLA ROCCA ⁶, on behalf of the OLTx Study Group

¹ Department of Anesthesiology and Intensive Care, Sapienza University, Rome, Italy; ² Azienda Ospedaliera Pisana, University of Pisa, Pisa, Italy; ³ Padua University Hospital, Padua, Italy; ⁴ Molinette Hospital, Città della Salute e della Scienza, Turin, Italy; ⁵ Niguarda Ca’ Granda Hospital, Milan, Italy; ⁶ Department of Medical Area, University of Udine, Udine, Italy; ⁷ National Transplant Center, Italian National Institute of Health (ISS), Rome, Italy

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BACKGROUND: Acute kidney injury (AKI) represents a frequent complication after orthotopic liver transplantation (OLT). This study aimed to evaluate early postoperative AKI incidence during the first 72 h after OLT, perioperative risk factors, and AKI impact on survival.
METHODS: From January 2011 to December 2013, 1681 patients underwent OLT in 19 centers and were enrolled in this prospective cohort study.
RESULTS: According to RIFLE criteria, AKI occurred in 367 patients, 21.8% (R: 5.8%, I: 6.4%, F: 4.8%, L: 4.8%). Based on multivariate analysis, intraoperative risk factors for AKI were: administration of 5-10 RBCs (OR 1.8, 95% CI 1.3-2.7), dopamine use (OR 1.6, 95% CI 1.2-2.3), post-reperfusion syndrome (OR 1.5, 95% CI 1.0-2.3), surgical complications (OR 2.0, 95% CI 1.3-3.0), and cardiological complications (OR 2.2, 95% CI 1.2-4.0). Postoperative risk factors were: norepinephrine (OR 1.4, 95% CI 1.0-2.0), furosemide (OR 4.2, 95% CI 3.0-5.9), more than 10 RBCs transfusion, (OR 3.7, 95% CI 1.4-10.5), platelets administration (OR 1.6, 95% CI 1.1-2.4), fibrinogen administration (OR 3.0, 95% CI, 1.5-6.2), hepatic complications (OR 4.6, 95% CI 2.9-7.5), neurological complications (OR 2.4, 95% CI 1.5-3.7), and infectious complications (OR 2.7, 95% CI 1.8-4.3). NO-AKI patients’ 5-year survival rate was higher than AKI patients (68.06, 95% CI 62.7-72.7 and 81.2, 95% CI 78.9-83.3, P<0.001).
CONCLUSIONS: AKI still remains an important risk factor for morbidity and mortality after OLT. Further research to develop new strategies aimed at preventing or minimizing post-OLT AKI is needed.

KEY WORDS: Liver transplantation; Acute kidney injury; Anesthesia; Critical care

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Publication History

Issue published online: April 11, 2022
Article first published online: October 28, 2021
Manuscript accepted: October 15, 2021
Manuscript revised: October 7, 2021
Manuscript received: May 11, 2021

Cite this article as

Fiorelli S, Biancofiore G, Feltracco P, Lavezzo B, De Gasperi A, Pompei L, et al.; OLTx Study Group. Acute kidney injury after liver transplantation, perioperative risk factors, and outcome: prospective observational study of 1681 patients (OLTx Study). Minerva Anestesiol 2022;88:248-58. DOI: 10.23736/S0375-9393.21.15860-2

the OLTx Study Group

Paola ACETO, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy; Cristina BARBARINO, Department of Medical Area, University of Udine, Udine, Italy; Alberto BENIGNI, ASST Papa Giovanni XXIII, Bergamo, Italy; Giandomenico BIANCOFIORE, Azienda Ospedaliera Pisana, University of Pisa, Pisa, Italy; Nicola BRIENZA, Bari University Polyclinic, Bari, Italy; Katia BRUNO, P. Stefanini Department of General and Specialistic Surgery, Sapienza University, Rome, Italy; Gaetano BURGIO, Department of Anesthesia and Critical Care Medicine, ISMETT IRCCS, Palermo, Italy; Stefania BUTTERA, Department of Medical Area, University of Udine, Udine, Italy; Mario CAPRIO, National Center for Radiation Protection and Computational Physics, Italian National Institute of Health (ISS), Rome, Italy; Massimo CARDILLO, National Transplant Center, Italian National Institute of Health (ISS), Rome, Italy; Giuseppe CARRAVETTA, Bari University Polyclinic, Bari, Italy; Alex CATTARUZZA, Department of Medical Area, University of Udine, Udine, Italy; Daniela COMI, ASST Papa Giovanni XXIII, Bergamo, Italy; Elisa COPETTI, Department of Medical Area, University of Udine, Udine, Italy; Mario DAURI, Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy; Andrea DE GASPERI, Niguarda Ca’ Granda Hospital, Milan, Italy; Francesco DE LORENZO, Department of Medical Area, University of Udine, Udine, Italy; Lesley DE PIETRI, Modena University Hospital, Modena, Italy; Giorgio DELLA ROCCA, Department of Medical Area, University of Udine, Udine, Italy; Paolo FELTRACCO, Padua University Hospital, Padua, Italy; Silvia FIORELLI, Department of Anesthesiology and Intensive Care, Sapienza University, Rome, Italy; Salvatore GROSSO, Verona University Hospital, Verona, Italy; Valentina GIAMPAOLO, Department of Medical Area, University of Udine, Udine, Italy; Ilaria GIULIANO, Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy; Saskia GRANZOTTI, Department of Medical Area, University of Udine, Udine, Italy; Cristiana LAICI, S. Orsola-Malpighi University Hospital, Bologna, Italy; Bruna LAVEZZO, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy; Lucia MASIERO, National Transplant Center, Italian National Institute of Health (ISS), Rome, Italy; Carola MATELLON, Department of Medical Area, University of Udine, Udine, Italy; Cristiano PIANGATELLI, AOU Ospedali Riuniti, Ancona, Italy; Federico PICCIONI, Anesthesia and Intensive Care Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy; Livia POMPEI, Department of Medical Area, University of Udine, Udine, Italy; Francesco PUGLIESE, Department of General and Specialistic Surgery, Sapienza University, Rome, Italy; Elisabetta PUSCEDDU, Brotzu-San Michele Hospital, Cagliari, Italy; Edoardo QUARENGHI, Maggiore Polyclinic Hospital, Milan, Italy; Andrea RICCI, National Transplant Center, Italian National Institute of Health (ISS), Rome, Italy; Giovanni SERENA, Department of Medical Area, University of Udine, Udine, Italy; Liliana SOLLAZZI, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy; Francesca STEFANI, Department of Medical Area, University of Udine, Udine, Italy; Silvia TESTA, National Transplant Center, Italian National Institute of Health (ISS), Rome, Italy.

Corresponding author e-mail

silvia.fiorelli@uniroma1.it

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