ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: FR-PO1087

Perioperative AKI in Pediatric Liver Transplant Patients

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Tufan pekkucuksen, Naile, University of FLorida, Gainesville, Florida, United States
  • Himes, Ryan, Ochsner Hospital for Children, New Orleans, Louisiana, United States
  • Young, Justin, Baylor College of Medicine, Houston, Texas, United States
  • Srivaths, Poyyapakkam, Texas Children's Hospital, Houston, Texas, United States
  • Desai, Moreshwar, Baylor College of Medicine, Houston, Texas, United States
  • Akcan Arikan, Ayse, Baylor College of Medicine, Houston, Texas, United States
Background

Acute kidney Injury (AKI) is a common complication in children in the post- orthotopic liver transplant (OLT) period. However, data regarding pre OLT AKI are scarce. We examined the incidence of perioperative AKI (7 days pre OLT- 7 days post OLR) in pediatric OLT population. AKI was defined using KDIGO criteria and HRS was defined using revised consensus recommendations of the International Club of Ascites, 2015 publication.

Methods

This is a single center retrospective chart review.

Results

A total hundred twenty-two pediatric patients (pts) underwent OLT between 11/2011- 3/2017. One patient who had known chronic kidney disease (CKD), was excluded. The median age was 2.5 years (IQR:0.83-10) and 71 were female (59%). Most common etiologies of liver disease were biliary atresia (BA) (68/121, 56%) and autoimmune idiopathic hepatitis (AIH) (25/121, 20%). Forty pts (33%) had perioperative AKI: 15% stage 1, 30% stage 2 and 55% stage 3. Of those, 15 (38%) pts had AKI pre-OLT, with hepatorenal syndrome (HRS) diagnosed in 11(73%). Twenty-five (62%) pts experienced post-OLT AKI. Most common etiologies for post OLT AKI were abdominal compartment syndrome (ACS), acute tubular necrosis (ATN) due to hypotension or bleeding, or nephrotoxin exposure. 29 pts (24%) received continuous renal replacement therapy (CRRT), 24 of those were started pre OLT due to AKI, fluid overload (FO) or hyperammonemia without AKI and 3 of those were discontinued after OLT. Five pts needed CRRT only post-OLT. Unfortunately, 7 AKI pts were never recognized by the clinical team.

Conclusion

AKI is common in perioperative period in children receiving OLT. HRS was the most common etiology for pre OLT. Post OLT, operative complications with ascites leading to ACS and hypotension leading ATN predominated. Majority of AKI pts were stage 3 and needed RRT. Unless monitored in a systemic fashion with structured diagnostic criteria, AKI can be missed by the clinical team. Short- and long-term outcomes of this population need to be elucidated through further studies.