Abstract
Background and Aims
AKI is a major concern in the management of candidates for liver transplantation. Post-LT AKI is associated with worse short- and long-term recipient and graft outcomes and the subsequent development of chronic kidney disease (CKD ).Most of the studies done on this are on deceased donor Liver transplant ,or if done on Living donor are retrospective in nature & there is inconsistency in studies regarding definition of AKI
To assess incidence, risk factor and outcomes of patient developing acute kidney injury(AKI) in patients undergoing living donor liver transplant(LT).
Method
This is a single center prospective study. Patients over age of 18 years undergoing living donor liver transplant were selected consecutively from Jan 19 to April 19, prospectively followed for 1 month post op to assess incidence of AKI(Early-<=7,Late >7 to <30) & reassessed at 3 months for persistence of renal dysfunction .Patients with fulminant liver failure, those undergoing combined liver kidney transplant & who died within first 72 hour post-LT were excluded .AKI was defined by KDIGO criteria. Preoperative, Intraoperative & Post operative variables were analysed for risk factor & patient outcomes by regression analysis.
Results
62 patients underwent LDLT between period of Jan 2019 to April 2019 .22(35%) patients developed AKI .15 (68%) had stage 1 AKI ,5 (23%) Stage 2 & 2(9%) had stage 3 AKI requiring CRRT.14 (64 %) patients had early AKI ,8 (36%) had late AKI.Acute CNI toxicity (3,14%) was most common cause of early AKI.Most common cause of Late AKI was Sepsis (7,11%).Use of vasopressors intra op & Past history of AKI (HRS) were the only statistically significant(p <0.001) risk factors for AKI .The mean ICU stay among patients with AKI was 7.2 ±4.2 days vs 4.5±1.2 days in patients without AKI .Median days to normalization of liver enzymes in non AKI group was 10 days vs 20 days in AKI group.2 (3.2%)patient had persistence of renal dysfunction at 3 month. 7(11.2%) patients died during analysis period, 2(3%) of them from AKI group.
Conclusion
- Incidence of AKI (35%) was higher in our study as compared to other cohort but lead to CKD in 2 patients . Past history of AKI (HRS) was a significant risk factor for Post op AKI though pre transplant e GFR did not differ in both group. Although AKI was transient but it lead to increase ventilator stay ,ICU stay and prolonged normalization of graft function in patients undergoing Living donor liver transplant.
A comparison of rates and severity of chronic kidney disease in deceased donor and living donor liver transplant recipients. Times matter.
