Acute kidney injury following liver transplantation: Definition and outcome

✍ Scribed by Yousri M. Barri; Edmund Q. Sanchez; Linda W. Jennings; Larry B. Melton; Steven Hays; Marlon F. Levy; Goran B. Klintmalm

• Publisher: John Wiley and Sons
• Year: 2009
• Tongue: English
• Weight: 192 KB
• Volume: 15
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.21682

✦ Synopsis

The incidence of acute kidney injury (AKI) has been reported to vary between 17% and 95% post-orthotopic liver transplantation. This variability may be related to the absence of a uniform definition of AKI in this setting. The purpose of this study was to identify the degree of AKI that is associated with long-term adverse outcome. Furthermore, to determine the best definition (for use in future studies) of AKI not requiring dialysis in post-liver transplant patients, we retrospectively reviewed the effect of 3 definitions of AKI post-orthotopic liver transplantation on renal and patient outcome between 1997 and 2005. We compared patients with AKI to a control group without AKI by each definition. AKI was defined in 3 groups as an acute rise in serum creatinine, from the pretransplant baseline, of Ͼ0.5 mg/dL, Ͼ1.0 mg/dL, or Ͼ50% above baseline to a value above 2 mg/dL. In all groups, the glomerular filtration rate was significantly lower at both 1 and 2 years post-transplant. Patient survival was worse in all groups. Graft survival was worse in all groups. The incidence of AKI was highest in the group with a rise in creatinine of Ͼ0.5 mg/dL (78%) and lowest in patients with a rise in creatinine of Ͼ50% above 2.0 mg/dL (14%). Even mild AKI, defined as a rise in serum creatinine of Ͼ0.5 mg/dL, was associated with reduced patient and graft survival. However, in comparison with the other definitions, the definition of AKI with the greatest impact on patient's outcome post-liver transplant was a rise in serum creatinine of Ͼ50% above baseline to Ͼ2 mg/dL.