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Journal of Cancer Research and Clinical Oncology

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01-07-2017 | Original Article – Clinical Oncology

Incidence and outcomes of acute kidney injury in patients with hepatocellular carcinoma after liver transplantation

Authors: Xiaohong Chen, Xiaoqiang Ding, Bo Shen, Jie Teng, Jianzhou Zou, Ting Wang, Jian Zhou, Nan Chen, Boheng Zhang

Published in: Journal of Cancer Research and Clinical Oncology | Issue 7/2017

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.

Barreto AG, Daher EF, Silva GB Jr et al (2015) Risk factors for acute kidney injury and 30-day mortality after liver transplantation. Ann Hepatol 14(5): 688–694PubMed

Barri YM, Sanchez EQ, Jennings LW et al (2009) Acute kidney injury following liver transplantation: definition and outcome. Liver Transpl 15(5):475–483. doi:10.1002/lt.21682 CrossRefPubMed

Cabezuelo JB, Ramírez P, Ríos A et al (2006) Risk factors of acute renal failure after liver transplantation. Kidney Int 69(6):1073–1080. doi:10.1038/sj.ki.5000216 CrossRefPubMed

Caragata R, Wyssusek KH, Kruger P (2016) Acute kidney injury following liver transplantation: a systematic review of published predictive models. Anaesth Intensive Care 44(2):251–261PubMed

Fan J, Yang GS, Fu ZR et al (2009) Liver transplantation outcomes in 1,078 hepatocellular carcinoma patients: a multi-center experience in Shanghai, China. J Cancer Res Clin Oncol 135(10):1403–1412. doi:10.1007/s00432-009-0584-6 CrossRefPubMed

Ferreira AC, Nolasco F, Carvalho D et al (2010) Impact of RIFLE classification in liver transplantation. Clin Transplant 24(3):394–400. doi:10.1111/j.1399-0012.2009.01087.x CrossRefPubMed

Grande L, Rimola A, Cugat E et al (1996) Effect of venovenous bypass on perioperative renal function in liver transplantation: results of a randomized, controlled trial. Hepatology 23(6):1418–1428. doi:10.1002/hep.510230618 CrossRefPubMed

Hilmi IA, Damian D, Al-Khafaji A et al (2015) Acute kidney injury following orthotopic liver transplantation: incidence, risk factors, and effects on patient and graft outcomes. Br J Anaesth 114(6):919–926. doi:10.1093/bja/aeu556 CrossRefPubMed

Iglesias JI, DePalma JA, Levine JS (2010) Risk factors for acute kidney injury following orthotopic liver transplantation: the impact of changes in renal function while patients await transplantation. BMC Nephrol 11:30. doi:10.1186/1471-2369-11-30 CrossRefPubMedPubMedCentral

Karapanagiotou A, Kydona C, Dimitriadis C et al (2012) Acute kidney injury after orthotopic liver transplantation. Transplant Proc 44(9):2727–2729. doi:10.1016/j.transproceed.2012.09.096 CrossRefPubMed

Karapanagiotou A, Dimitriadis C, Papadopoulos S et al (2014) Comparison of RIFLE and AKIN criteria in the evaluation of the frequency of acute kidney injury in post-liver transplantation patients. Transplant Proc 46(9):3222–3227. doi:10.1016/j.transproceed.2014.09.161 CrossRefPubMed

Kim JM, Jo YY, Na SW et al (2014) The predictors for continuous renal replacement therapy in liver transplant recipients. Transplant Proc 46(1):184–191. doi:10.1016/j.transproceed.2013.07.075 CrossRefPubMed

Klaus F, Keitel da Silva C, Meinerz G et al (2014) Acute kidney injury after liver transplantation: incidence and mortality. Transplant Proc 46(6):1819–1821. doi:10.1016/j.transproceed.2014.05.053 CrossRefPubMed

Kong HY, Chen F, He Y et al (2013) Intrarenal resistance index for the assessment of acute renal injury in a rat liver transplantation model. BMC Nephrol 14:55. doi:10.1186/1471-2369-14-55 CrossRefPubMedPubMedCentral

Kumagi T, Hiasa Y, Hirschfield GM (2009) Hepatocellular carcinoma for the non-specialist. BMJ 339:b5039. doi:10.1136/bmj.b5039 CrossRefPubMed

Kundakci A, Pirat A, Komurcu O et al (2010) Rifle criteria for acute kidney dysfunction following liver transplantation: incidence and risk factors. Transplant Proc 42(10):4171–4174. doi:10.1016/j.transproceed.2010.09.137 CrossRefPubMed

Lewandowska L, Matuszkiewicz-Rowinska J (2011) Acute kidney injury after procedures of orthotopic liver transplantation. Ann Transplant 16(2):103–108CrossRefPubMed

Li ZX, Wang MC, Zhang YC et al (2015) Hemodynamics and vasoactive substance levels during renal congestion that occurs in the anhepatic phase of liver transplantation. World J Gastroenterol 21(18):5482–5487. doi:10.3748/wjg.v21.i18.5482 CrossRefPubMedPubMedCentral

Mehta RL, Kellum JA, Shah SV et al (2007) Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 11(2):R31. doi:10.1186/cc5713 CrossRefPubMedPubMedCentral

Mehta RL, Cerdá J, Burdmann EA et al (2015) International Society of Nephrology’s 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology. Lancet 385(9987):2616–2643. doi:10.1016/S0140-6736(15)60126-X CrossRefPubMed

Narciso RC, Ferraz LR, Mies S et al (2013) Impact of acute kidney injury exposure period among liver transplantation patients. BMC Nephrol 14:43. doi:10.1186/1471-2369-14-43 CrossRefPubMedPubMedCentral

National Kidney Foundation (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39(2 suppl 1):S1–S266

O’Riordan A, Wong V, McQuillan R et al (2007) Acute renal disease, as defined by the RIFLE criteria, post-liver transplantation. Am J Transplant 7(1):168–176. doi:10.1111/j.1600-6143.2006.01602.x CrossRefPubMed

Rueggeberg A, Boehm S, Napieralski F et al (2008) Development of a risk stratification model for predicting acute renal failure in orthotopic liver transplantation recipients. Anaesthesia 63(11):1174–1180. doi:10.1111/j.1365-2044.2008.05604.x CrossRefPubMed

Smoter P, Nyckowski P, Grat M et al (2014) Risk factors of acute renal failure after orthotopic liver transplantation: single-center experience. Transplant Proc 46(8):2786–2789. doi:10.1016/j.transproceed CrossRefPubMed

Starzl TE, Marchioro TL, Vonkaulla KN et al (1963) Homotransplantation of the liver in humans. Surg Gynecol Obstet 117:659–676PubMedPubMedCentral

Tinti F, Umbro I, Meçule A et al (2010) RIFLE criteria and hepatic function in the assessment of acute renal failure in liver transplantation. Transplant Proc 42(4):1233–1236. doi:10.1016/j.transproceed.2010.03.128 CrossRefPubMed

Utsumi M, Umeda Y, Sadamori H et al (2013) Risk factors for acute renal injury in living donor liver transplantation: evaluation of the RIFLE criteria. Transpl Int 26(8):842–852. doi:10.1111/tri.12138 CrossRefPubMed

Velidedeoglu E, Crawford MD, Desai NM et al (2002) Predictors of late kidney dysfunction post-liver transplantation. Transplant Proc 34(8):3315–3316CrossRefPubMed

Wei Y, Zhang L, Lin H et al (2006) Factors related to post-liver transplantation acute renal failure. Transplant Proc 38(9):2982–2984. doi:10.1016/j.transproceed.2006.08.156 CrossRefPubMed

Wyssusek KH, Keys AL, Yung J et al (2015) Evaluation of perioperative predictors of acute kidney injury post orthotopic liver transplantation. Anaesth Intensive Care 43(6):757–763PubMed

Xu X, Ling Q, Wei Q et al (2010) An effective model for predicting acute kidney injury after liver transplantation. Hepatobiliary Pancreat Dis Int 9(3):259–263PubMed

Xue M, Lv C, Chen X et al (2015) Effect of interleukin-2 receptor antagonists on new-onset diabetes after liver transplantation: A retrospective cohort study. J Diabetes. doi:10.1111/1753-0407.12356

Yu L, Dai Z, Wang Z et al (2011) Prognostic indicators for tumor recurrence after liver transplantation in hepatocellular carcinoma and related molecular targeted therapy. Int Soc Cell 81(suppl 1):116–122. doi:10.1159/000333273

Zhou J, Fan J, Wu ZQ et al (2005) Liver transplantation for patients with hepatocellular carcinoma at the Liver Cancer Institute of Fudan University, China. Chin Med J (Engl) 118(8):654–659

Zhu M, Li Y, Xia Q et al (2010) Strong impact of acute kidney injury on survival after liver transplantation. Transplant Proc 42(9):3634–3638. doi:10.1016/j.transproceed.2010.08.059 CrossRefPubMed

Title: Incidence and outcomes of acute kidney injury in patients with hepatocellular carcinoma after liver transplantation
Authors: Xiaohong Chen
Xiaoqiang Ding
Bo Shen
Jie Teng
Jianzhou Zou
Ting Wang
Jian Zhou
Nan Chen
Boheng Zhang
Publication date: 01-07-2017
Publisher: Springer Berlin Heidelberg
Published in: Journal of Cancer Research and Clinical Oncology / Issue 7/2017
Print ISSN: 0171-5216
Electronic ISSN: 1432-1335
DOI: https://doi.org/10.1007/s00432-017-2376-8

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