Liver transplantation
Acute Renal Failure After Liver Transplantation: Incidence, Etiology, Therapy, and Outcome

https://doi.org/10.1016/j.transproceed.2006.01.074Get rights and content

Abstract

Acute renal failure (ARF) was a frequent complication after orthotopic liver transplantation (OLT) when ARF was defined by a calculated glomerular filtration rate decrease of >50% or by a doubled serum creatinine above 2.5 mg/dL within the first week after OLT. We analyzed 1352 liver transplant recipients in retrospective fashion with regard to the incidence, etiology, therapy, and outcome of ARF; 162 patients developed ARF within the first week after OLT (12%), among whom 157 patients (97%) were recompensated by postoperative day 28. Altogether 52 patients (32%) received an average of 6 hemodialysis treatments, excluding the 5 patients (3%) who developed end-stage renal failure. Risk factors for this complication included hepatorenal syndrome type II, a glomerular filtration rate of <50 mL/min, and a diagnosis of hepatitis C.

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Patients and methods

Between 1988 and 2001, we retrospectively analyzed the 1352 patients, who had undergone OLT with regard to the incidence, etiology, therapy, and outcome of ARF, which was defined as a calculated glomerular filtration rate (GFR) (Cockroft-Gault, MDRD) decreased more than 50% or a serum creatinine that had doubled above 2.5 mg/dL within the first week after OLT. Patients with hepatorenal syndrome (HRS) type I pre-OLT were excluded from the study.

Results

Among 162 patients who developed ARF within the first week after OLT (11.9%), the mean age was 53.7 years and 89 were men. The duration of chronic disease leading to OLT was 36 to 469 months. Their overall 5-year patient and graft survival rates were 89.4% and 82%, respectively. The 162 recipients with ARF had the following indications for OLT: alcoholic cirrhosis (n = 68); primary biliary cirrhosis, primary sclerosing cholangitis, autoimmune hepatitis (n = 23); hepatitis B-related liver

Discussion

ARF after OLT showed good prognosis with a recompensation rate of 97% within 4 weeks after surgery. Since multifactorial genesis is the most frequent cause of ARF, only two major risk factors have been associated with ARF after OLT: creatinine above 1.5 mg/dL and GFR <50 mL/min. Among the 3% of patients who develop ARF after OLT are three risk factors: HRS type II, GFR <30 mL/min, and diagnosis of hepatitis C.1 To be able to identify this in advance and apply optimally adjusted

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