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13.03.2017 | Original Article – Clinical Oncology | Ausgabe 7/2017

Journal of Cancer Research and Clinical Oncology 7/2017

Incidence and outcomes of acute kidney injury in patients with hepatocellular carcinoma after liver transplantation

Zeitschrift:
Journal of Cancer Research and Clinical Oncology > Ausgabe 7/2017
Autoren:
Xiaohong Chen, Xiaoqiang Ding, Bo Shen, Jie Teng, Jianzhou Zou, Ting Wang, Jian Zhou, Nan Chen, Boheng Zhang
Wichtige Hinweise
A comment to this article is available at https://​doi.​org/​10.​1007/​s00432-017-2492-5.

Abstract

Purpose

To describe the incidence and outcomes linked with acute kidney injury (AKI) after liver transplantation (LT) in hepatocellular carcinoma (HCC) patients.

Methods

From January 2003 to February 2011, HCC patients undergoing LT were retrospectively enrolled. Patient with a glomerular filtration rate (GFR) <60 mL/min/1.73 m2 was excluded. AKI was defined and classified according to the AKIN criteria.

Results

Of the 566 eligible patients, AKI was found in 109 (19.26%) patients (stage I, 66 cases; stage II, 15 cases; and stage III, 28 cases). Risk factors for AKI were the long anhepatic time (OR = 3.59, P = 0.009) and prolonged duration of systolic blood pressure (SBP) < 90 mmHg (OR = 1.07, P < 0.0001). Post-LT AKI was an independent risk factor associated with 30-day mortality (HR = 4.05, P = 0.047). Complete recovery occurred in 84 (77.06%) of all AKI episodes within 1 month after operation, while 25 patients (22.94%) suffered from prolonged AKI. Patients with prolonged AKI had a poorer 1-year survival than those with transient AKI (40 vs 86.90%; P < 0.0001). Patients with severe AKI more often developed prolonged AKI. 13 patients (52%) of the prolonged AKI progressed to chronic kidney disease (CKD) defined as eGFR <60 mL/min/1.73 m2 after 1 year post-operation.

Conclusions

Post-LT AKI is not an uncommon complication. Intra-operative hemodynamic instability is crucial in the development of post-LT AKI and deserves more attention. Most post-LT AKI is transient and reversible, while the prolonged form may predict a decrease survival.

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