Liver transplantation and peri- operative changes to renal function

Česká verzia

Authors: E. Kieslichová ¹ ; O. Schück ²; I. Smrčková ³; J. Granátová ⁵; J. Skibová ¹; D. Merta ¹; P. Trunečka ⁴
Authors place of work: Klinika anesteziologie, resuscitace a intenzivní péče IKEM Praha, přednostka MU Dr. Eva Kieslichová ¹; Klinika nefrologie IKEM Praha, přednosta prof. MU Dr. Ondřej Viklický, CSc. ²; Oddělení klinické biochemie IKEM Praha, přednosta prof. MU Dr. Antonín Jabor, CSc. ³; Transplantcentrum IKEM Praha, přednosta prim. MU Dr. Pavel Trunečka, CSc. ⁴; Oddělení klinické biochemie Fakultní Thomayerovy nemocnice Praha, prim. MU Dr. Zora Hamrlová ⁵
Published in the journal: Vnitř Lék 2009; 55(12): 1126-1134
Category: Original Contributions

Summary

The aim of the study:
Was to analyze in detail perioperative changes of renal function during orthotopic liver transplantation (OLT) and to identify risk factors, that were associated with the need of renal replacement therapy (RRT) during the first week after liver transplantation. Methods: Prospective study of 50 consecutive patients undergoing OLT was performed. Selected laboratory and clinical parameters were monitored prior to the procedure, after reperfusion, at the end of the procedure, and at 12 hours after the procedure. In the first post‑transplant week, necessity to use RRT in the presence of acute kidney injury was monitored and the analysis of risk factors for the need for RRT was performed. Patient survival, graft function, need for dialysis and selected laboratory parameters were assessed at one year post‑transplant. Results: During OLT, there was an increase in S_cr and S_urea, which persisted as late as 12 hours post‑transplant. There was a decrease in U_cr and U_urea and an increase in S_Na and S_K. During the procedure any increase in S_cyst were observed, increase the values were recorded 12 hours after surgery. S_bili level decreased. There was a rise in the urinary levels of total protein, albumin and β₂-microglobulin. U_prot/ U_cr increased significantly after reperfusion, with a peak after the procedure. At 12 hours after the procedure, there was a decrease in U_prot/ U_cr, but the values were still many times higher than those seen preoperatively. RRT was necessary in 14% cases. Risk factors for acute kidney injury requiring RRT included a higher APACHE score, higher BMI, higher preoperative S_cr and S_urea, hepatorenal syndrome pretransplant, blood loss and intraoperative hemodynamic instability, postoperative complications and dysfunction of the liver graft. One year after OLT, there was no difference in followed laboratory values between patients requiring postoperative RRT and others; no patient was treated with dialysis. Conclusion: OLT has a major impact on glomerular and tubular renal functions. Our data suggest that patients surviving acute renal injury treated with RRT in the early postoperative period have a high chance of restoring renal function. A sensitive marker of renal injury during OLT seems to be perioperative proteinuria.

Key words:
liver transplantation – acute kidney injury – renal replacement therapy

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