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Kidney Week

Abstract: PO0020

AKI After Procedures of Orthotopic Liver Transplant: Risk Factors, Renal Outcomes and Survival

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Antiga lopez, Francisco javier, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, DF, Mexico
  • Vega, Olynka, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, DF, Mexico
  • Correa-Rotter, Ricardo, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, DF, Mexico
Background

The incidence of acute renal injury (AKI) after orthotopic liver transplantation (OLT) ranges between 40 and 70%. The etiology of this syndrome is multifactorial.

Methods

Medical records of patients undergoing OLT in the period from January 2012 to August 2019 were reviewed. A total of 355 patients were included. 171 patients presented AKI. Baseline characteristics, variables during surgery and variables during their stay in intensive were analyzed. Renal outcomes and survival were also analyzed.

Results

In the group without AKI age mean was 45.8 years and 37% were men, in the group with AKI the age mean was 51.2 years and 54% were men (P = 0.001). Mean baseline creatinine was 0.77 while vs 0.88 mg/dl P = 0.003. Furosemide prior to transplantation was found: 51.6% vs 71.9% P = 0.001. A difference was also found between the incidence of AKI and the number of AKI events in the 3 months prior to transplantation (17.3% vs. 37.4% P = 0.001) and (0.21 vs. 0.53)
During surgery. Difference was found in maximum lactate, maximum dose of norepinephrine and vasopressin use during surgery: (5.1 vs. 5.8 P = 0.014), (0.59 vs 0.34 P = 0.001), ( 36% vs 51% P = 0.003)
Differences were also found in drained ascites and anehepatic period: (1508 vs 973 SD vs 1871 P = 0.021) and (52.9 vs 57.4 P = 0.014).
In the stay in the ICU, there was a difference in the income of liquids first and second 8 hours after transplant (1319 vs 1984 P = 0.001) and (1208 vs 1606 P = 0.009), norepinephrine dose in the first 24 hours (0.14 vs 0.27 P = 0.001 ), use of vancomycin and anidulafungin (27.1% vs. 42.1% P = 0.02) and (3.8% vs. 13.4% P = 0.001), transfusion of blood derivatives 33.15% vs 59% (P = 0.001).
There was difference in creatinine and GFR at the end of hospitalization (0.67 vs 0.97 P = 0.001) and (104 vs 82.6 P = 0.001).
Survival at 7 days after the transplant 100% vs 96.5% P = 0.01. Survival 30 days 99.5% vs 93.6% P = 0.002.

Conclusion

The incidence of AKI in the first 7 days was 48%, which is consistent with that reported in the world literature. The development of AKI seems to be multifactorial influencing baseline characteristics of patients before transplantation and renal insults during surgery and intensive care stay. AKI was associated with higher mortality at 7 and 30 days, in addition to lower GFR at patient discharge and higher risk of CKD.