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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

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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