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Early acute kidney injury after liver transplantation: Predisposing factors and clinical implications

AIM To investigate the additional clinical impact of hepatic ischaemia reperfusion injury(HIRI) on patients sustaining acute kidney injury(AKI) following liver transplantation.METHODS This was a single-centre retrospective study of consecutive adult patients undergoing orthotopic liver transplantati...

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Published in:World journal of hepatology 2017-06, Vol.9 (18), p.823-832
Main Authors: Rahman, Suehana, Davidson, Brian R, Mallett, Susan V
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description AIM To investigate the additional clinical impact of hepatic ischaemia reperfusion injury(HIRI) on patients sustaining acute kidney injury(AKI) following liver transplantation.METHODS This was a single-centre retrospective study of consecutive adult patients undergoing orthotopic liver transplantation(OLT) between January 2013 and June 2014. Early AKI was identified by measuring serum creatinine at 24 h post OLT(> 1.5 × baseline) or by the use of continuous veno-venous haemofiltration(CVVHF) during the early post-operative period. Patients with and without AKI were compared to identify risk factors associated with this complication. Peak serum aspartate aminotransferase(AST) within 24 h post-OLT was used as a surrogate marker for HIRI and severity was classified as minor(< 1000 IU/L), moderate(1000-5000 IU/L) or severe(> 5000 IU/L). The impact on time to extubation, intensive care length of stay, incidence of chronic renal failure and 90-d mortality were examined firstly for each of the two complications(AKI and HIRI) alone and then as a combined outcome. RESULTS Out of the 116 patients included in the study, 50% developed AKI, 24% required CVVHF and 70% sustainedmoderate or severe HIRI. Median peak AST levels were 1248 IU/L and 2059 IU/L in the No AKI and AKI groups respectively(P = 0.0003). Furthermore, peak serum AST was the only consistent predictor of AKI on multivariate analysis P = 0.02. AKI and HIRI were individually associated with a longer time to extubation, increased length of intensive care unit stay and reduced survival. However, the patients who sustained both AKI and moderate or severe HIRI had a longer median time to extubation(P < 0.001) and intensive care length of stay(P = 0.001) than those with either complication alone. Ninety-day survival in the group sustaining both AKI and moderate or severe HIRI was 89%, compared to 100% in the groups with either or neither complication(P = 0.049). CONCLUSION HIRI has an important role in the development of AKI post-OLT and has a negative impact on patient outcomes, especially when occurring alongside AKI.
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Early AKI was identified by measuring serum creatinine at 24 h post OLT(&amp;gt; 1.5 × baseline) or by the use of continuous veno-venous haemofiltration(CVVHF) during the early post-operative period. Patients with and without AKI were compared to identify risk factors associated with this complication. Peak serum aspartate aminotransferase(AST) within 24 h post-OLT was used as a surrogate marker for HIRI and severity was classified as minor(&amp;lt; 1000 IU/L), moderate(1000-5000 IU/L) or severe(&amp;gt; 5000 IU/L). The impact on time to extubation, intensive care length of stay, incidence of chronic renal failure and 90-d mortality were examined firstly for each of the two complications(AKI and HIRI) alone and then as a combined outcome. RESULTS Out of the 116 patients included in the study, 50% developed AKI, 24% required CVVHF and 70% sustainedmoderate or severe HIRI. Median peak AST levels were 1248 IU/L and 2059 IU/L in the No AKI and AKI groups respectively(P = 0.0003). Furthermore, peak serum AST was the only consistent predictor of AKI on multivariate analysis P = 0.02. AKI and HIRI were individually associated with a longer time to extubation, increased length of intensive care unit stay and reduced survival. However, the patients who sustained both AKI and moderate or severe HIRI had a longer median time to extubation(P &amp;lt; 0.001) and intensive care length of stay(P = 0.001) than those with either complication alone. Ninety-day survival in the group sustaining both AKI and moderate or severe HIRI was 89%, compared to 100% in the groups with either or neither complication(P = 0.049). CONCLUSION HIRI has an important role in the development of AKI post-OLT and has a negative impact on patient outcomes, especially when occurring alongside AKI.</description><identifier>ISSN: 1948-5182</identifier><identifier>EISSN: 1948-5182</identifier><identifier>DOI: 10.4254/wjh.v9.i18.823</identifier><identifier>PMID: 28706581</identifier><language>eng</language><publisher>United States: Baishideng Publishing Group Inc</publisher><subject>Retrospective Study</subject><ispartof>World journal of hepatology, 2017-06, Vol.9 (18), p.823-832</ispartof><rights>The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved. 2017</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c434t-66bc04634a32fad4b2f56af57a81aab614e612ee3a8520053f71b0ab17812c003</citedby><cites>FETCH-LOGICAL-c434t-66bc04634a32fad4b2f56af57a81aab614e612ee3a8520053f71b0ab17812c003</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Uhttp://image.cqvip.com/vip1000/qk/71422X/71422X.jpg</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5491405/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5491405/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28706581$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rahman, Suehana</creatorcontrib><creatorcontrib>Davidson, Brian R</creatorcontrib><creatorcontrib>Mallett, Susan V</creatorcontrib><title>Early acute kidney injury after liver transplantation: Predisposing factors and clinical implications</title><title>World journal of hepatology</title><addtitle>World Journal of Hepatology</addtitle><description>AIM To investigate the additional clinical impact of hepatic ischaemia reperfusion injury(HIRI) on patients sustaining acute kidney injury(AKI) following liver transplantation.METHODS This was a single-centre retrospective study of consecutive adult patients undergoing orthotopic liver transplantation(OLT) between January 2013 and June 2014. Early AKI was identified by measuring serum creatinine at 24 h post OLT(&amp;gt; 1.5 × baseline) or by the use of continuous veno-venous haemofiltration(CVVHF) during the early post-operative period. Patients with and without AKI were compared to identify risk factors associated with this complication. Peak serum aspartate aminotransferase(AST) within 24 h post-OLT was used as a surrogate marker for HIRI and severity was classified as minor(&amp;lt; 1000 IU/L), moderate(1000-5000 IU/L) or severe(&amp;gt; 5000 IU/L). The impact on time to extubation, intensive care length of stay, incidence of chronic renal failure and 90-d mortality were examined firstly for each of the two complications(AKI and HIRI) alone and then as a combined outcome. RESULTS Out of the 116 patients included in the study, 50% developed AKI, 24% required CVVHF and 70% sustainedmoderate or severe HIRI. Median peak AST levels were 1248 IU/L and 2059 IU/L in the No AKI and AKI groups respectively(P = 0.0003). Furthermore, peak serum AST was the only consistent predictor of AKI on multivariate analysis P = 0.02. AKI and HIRI were individually associated with a longer time to extubation, increased length of intensive care unit stay and reduced survival. However, the patients who sustained both AKI and moderate or severe HIRI had a longer median time to extubation(P &amp;lt; 0.001) and intensive care length of stay(P = 0.001) than those with either complication alone. Ninety-day survival in the group sustaining both AKI and moderate or severe HIRI was 89%, compared to 100% in the groups with either or neither complication(P = 0.049). CONCLUSION HIRI has an important role in the development of AKI post-OLT and has a negative impact on patient outcomes, especially when occurring alongside AKI.</description><subject>Retrospective Study</subject><issn>1948-5182</issn><issn>1948-5182</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><recordid>eNpVUU1vEzEUtBCIVqFXjshHLtn6e70ckFBVoFIlOMDZeuv1Jg6OvbV3U-Xf46ohKj7YI3vevPEbhN5T0ggmxfXjbtscusZT3WjGX6FL2gm9llSz1y_wBboqZUfqEkJ1Wr9FF0y3RElNL5G7hRyOGOwyO_zHD9EdsY-7Jde7cXYZB3-o-5whlilAnGH2KX7CP7MbfJlS8XGDR7BzygVDHLANPnoLAfv9FCp4opd36M0Iobir07lCv7_e_rr5vr7_8e3u5sv92gou5rVSvSVCcQGcjTCIno1SwShb0BSgV1Q4RZlzHLRkhEg-trQn0NNWU2YJ4Sv0-Vl3Wvq9G6yL1XgwU_Z7yEeTwJv_X6Lfmk06GCk6KqrgCn08CeT0sLgym70v1oX6c5eWYmjHSO2saFupzTPV5lRKduO5DSXmKR5T4zGHztR4TI2nFnx4ae5M_xdGJfCT4jbFzUOd7Jmj21a0TAtJhBadrHalqqiOgf8Fh6ieYA</recordid><startdate>20170628</startdate><enddate>20170628</enddate><creator>Rahman, Suehana</creator><creator>Davidson, Brian R</creator><creator>Mallett, Susan V</creator><general>Baishideng Publishing Group Inc</general><scope>2RA</scope><scope>92L</scope><scope>CQIGP</scope><scope>~WA</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20170628</creationdate><title>Early acute kidney injury after liver transplantation: Predisposing factors and clinical implications</title><author>Rahman, Suehana ; Davidson, Brian R ; Mallett, Susan V</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c434t-66bc04634a32fad4b2f56af57a81aab614e612ee3a8520053f71b0ab17812c003</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Retrospective Study</topic><toplevel>online_resources</toplevel><creatorcontrib>Rahman, Suehana</creatorcontrib><creatorcontrib>Davidson, Brian R</creatorcontrib><creatorcontrib>Mallett, Susan V</creatorcontrib><collection>维普_期刊</collection><collection>中文科技期刊数据库-CALIS站点</collection><collection>维普中文期刊数据库</collection><collection>中文科技期刊数据库- 镜像站点</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>World journal of hepatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rahman, Suehana</au><au>Davidson, Brian R</au><au>Mallett, Susan V</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early acute kidney injury after liver transplantation: Predisposing factors and clinical implications</atitle><jtitle>World journal of hepatology</jtitle><addtitle>World Journal of Hepatology</addtitle><date>2017-06-28</date><risdate>2017</risdate><volume>9</volume><issue>18</issue><spage>823</spage><epage>832</epage><pages>823-832</pages><issn>1948-5182</issn><eissn>1948-5182</eissn><abstract>AIM To investigate the additional clinical impact of hepatic ischaemia reperfusion injury(HIRI) on patients sustaining acute kidney injury(AKI) following liver transplantation.METHODS This was a single-centre retrospective study of consecutive adult patients undergoing orthotopic liver transplantation(OLT) between January 2013 and June 2014. Early AKI was identified by measuring serum creatinine at 24 h post OLT(&amp;gt; 1.5 × baseline) or by the use of continuous veno-venous haemofiltration(CVVHF) during the early post-operative period. Patients with and without AKI were compared to identify risk factors associated with this complication. Peak serum aspartate aminotransferase(AST) within 24 h post-OLT was used as a surrogate marker for HIRI and severity was classified as minor(&amp;lt; 1000 IU/L), moderate(1000-5000 IU/L) or severe(&amp;gt; 5000 IU/L). The impact on time to extubation, intensive care length of stay, incidence of chronic renal failure and 90-d mortality were examined firstly for each of the two complications(AKI and HIRI) alone and then as a combined outcome. RESULTS Out of the 116 patients included in the study, 50% developed AKI, 24% required CVVHF and 70% sustainedmoderate or severe HIRI. Median peak AST levels were 1248 IU/L and 2059 IU/L in the No AKI and AKI groups respectively(P = 0.0003). Furthermore, peak serum AST was the only consistent predictor of AKI on multivariate analysis P = 0.02. AKI and HIRI were individually associated with a longer time to extubation, increased length of intensive care unit stay and reduced survival. However, the patients who sustained both AKI and moderate or severe HIRI had a longer median time to extubation(P &amp;lt; 0.001) and intensive care length of stay(P = 0.001) than those with either complication alone. Ninety-day survival in the group sustaining both AKI and moderate or severe HIRI was 89%, compared to 100% in the groups with either or neither complication(P = 0.049). CONCLUSION HIRI has an important role in the development of AKI post-OLT and has a negative impact on patient outcomes, especially when occurring alongside AKI.</abstract><cop>United States</cop><pub>Baishideng Publishing Group Inc</pub><pmid>28706581</pmid><doi>10.4254/wjh.v9.i18.823</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record>
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title Early acute kidney injury after liver transplantation: Predisposing factors and clinical implications
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