ACUTE KIDNEY INJURY IN ORTHOTOPIC
LIVER TRANSPLANT RECIPIENTS
S.A.K. NOOR MOHAMED, M.EDWIN FERNANDO, R.VIJAYAKUMAR,
A.EZHIL ARASI, S.THIRUMAALAVAN, T.RAJARAJAN
Dept .of Nephrology, Govt. Stanley Medical College & hospital,
Chennai, Tamilnadu .
INTRODUCTION
Acute kidney injury after orthotopic liver transplantation (OLT) is a
common complication which has severe impact on early prognosis of
recipients.
AIM
To analyse the incidence, risk factors, and outcome of acute kidney
injury (AKI) among cadaveric liver transplant recipients during immediate
post operative period in our centre
MATERIALS AND METHODS
•
A retrospective analytical study
•
Number-32
•
Study period- Jan 2009 to Nov 2011
•
Population- Cadaveric Liver transplant recipients
All patients demographic,clinical,biochemical profiles of pre and post
operative states were charecterised which includes age,sex,
nativeliverdisease, comorbid illness, preoperative urine output,
preoperative s.creatinine, duration of surgery, intraoperative hypotension
intra/post operative inotrophic support, blood transfusions, post operative
ventilator support, post operative urine output, liver graft function,
reoperation, post operative s.creatinine, electrolytes, post operative
infections,drug therapy and haemodialysis support.
•
For analysis purposes, recipients were stratified into two categories
AKI/ non-AKI based on RIFLE criteria
All data were analysed as the mean/SD
Multivariate analysis was done to assess the various riskfactors
RESULTS
Indications for transplant:DCLD(Viral,Alcohol,Cryptogenic,Budd-chiari
syndrome related)and HepatoCellularCarcinoma
Ratio
prevalence
AKI
15/32
46.8%
HD in AKI
3/15
20%
Mortality in AKI
12/15
80%
Mortality in HD pts
3/3
100%
Overall mortality
12/32
37.5%
According to RIFLE criteria: risk-1pt,injury-5pts,failure-9pts
Mean duration of postoperative AKI-5.6days
AKI
non-AKI
total
17
15
2
43.8
0.8
32
27
5
45.6
Recipients
Male
Female
Age
preoperative s.creatinine,
15
12
3
47.5
1.04
post operative s.creatinine
3.04
hypernatremia
26%
5%
hypomagnesinia
50%
30%
0.9
common riskfactors for all AKI pts include 10-12 hours duration of
surgery,intraoperative hypotension, intra/postoperative inotropic
support,multiple blood transfusions,prolonged post operative ventilator
support, hypoalbuminemia,tacrolimus,and ganciclovir therapy.
specific riskfactors include reperfusion syndrome, liver graft dysfunction,
reoperation, magnesium chloride therapy and post operative infections.
CONCLUSION

Acute kidney injury is most common among orthotopic liver
transplant recipients in immediate post operative period in our
centre(prevalence-46.8%)

Outcome Predictors include prolonged duration of surgery,
hypotension, inotropic support, post operative ventilator support
reperfusion syndrome, liver graft dysfunction, reoperation, post
operative infections, hypoalbuminemia, drug therapy, and
haemodialysis

Mortality is higher in AKI group.