Background and Aims: Acute kidney injury (AKI) is a major cause of mortality after liver transplantation (LT). Graft ischaemic-reperfusion injury (IRI) seems to have a role on the occurrence of post-LT AKI. Liver transplantation from DCD is a model with increased occurrence of AKI compared to donors after brain death (DBD). This is likely to be related to a more severe IRI sustained by the graft. Aims of the study are (1) to evaluate incidence and classification of AKI (2) to identify risk factors for AKI after LT, in different models of ischaemia of the graft (DCD vs. DBD). Methods: This is a retrospective single-centre study of 1150 patients undergone LT at Queen Elizabeth Hospital Birmingham from 2007 to 2014. Exclusion criteria included: urgent transplantation (=66), combined with other organs (=16), living donor liver transplants (=7) and previous renal (=1) grafting. We considered: renal function pre-transplant and daily within one week post-transplant, character- istics of recipient, donor type (DCD vs. DBD), graft variables and indicators of initial graft function. AKI was defined and classified on the basis of KDIGO Guidelines (2012). Results: We considered 1060 LT patients (813 DBD and 247 DCD). The total incidence of AKI, and AKI stage 3 in particular, were significantly higher in DCD vs. DBD (see Table) despite better pre-LT liver and renal functions. The risk factors for AKI are different in DBD (INR, bilirubin, creatinine, GFR < 60, MELD, donor age, HCV) vs. DCD (recipient warm ischaemia time-WIT, AST peak). Furthermore, we identified a cut-off of 37 minutes in recipient-WIT as predictive of AKI stage 3 in recipients from DCD.

Ischaemic-reperfusion injury and different risk factors for acute kidney injury in donation after circulatory death liver transplantation. UK single centre study / Umbro, I.; Tinti, F.; Evison, F.; Kalisvaart, M.; Sharif, A.; Gunson, B.; Mitterhofer, A. P.; Ferguson, J.; Muiesan, P.. - In: JOURNAL OF HEPATOLOGY. - ISSN 0168-8278. - 66:Supplement 1(2017), pp. S183-S183. (Intervento presentato al convegno International Liver Congress / 52nd Annual Meeting of the European-Association-for-the-Study-of-the-Liver tenutosi a Amsterdam, NETHERLANDS) [10.1016/S0168-8278(17)30654-2].

Ischaemic-reperfusion injury and different risk factors for acute kidney injury in donation after circulatory death liver transplantation. UK single centre study

Umbro, I.;Tinti, F.;Mitterhofer, A. P.;
2017

Abstract

Background and Aims: Acute kidney injury (AKI) is a major cause of mortality after liver transplantation (LT). Graft ischaemic-reperfusion injury (IRI) seems to have a role on the occurrence of post-LT AKI. Liver transplantation from DCD is a model with increased occurrence of AKI compared to donors after brain death (DBD). This is likely to be related to a more severe IRI sustained by the graft. Aims of the study are (1) to evaluate incidence and classification of AKI (2) to identify risk factors for AKI after LT, in different models of ischaemia of the graft (DCD vs. DBD). Methods: This is a retrospective single-centre study of 1150 patients undergone LT at Queen Elizabeth Hospital Birmingham from 2007 to 2014. Exclusion criteria included: urgent transplantation (=66), combined with other organs (=16), living donor liver transplants (=7) and previous renal (=1) grafting. We considered: renal function pre-transplant and daily within one week post-transplant, character- istics of recipient, donor type (DCD vs. DBD), graft variables and indicators of initial graft function. AKI was defined and classified on the basis of KDIGO Guidelines (2012). Results: We considered 1060 LT patients (813 DBD and 247 DCD). The total incidence of AKI, and AKI stage 3 in particular, were significantly higher in DCD vs. DBD (see Table) despite better pre-LT liver and renal functions. The risk factors for AKI are different in DBD (INR, bilirubin, creatinine, GFR < 60, MELD, donor age, HCV) vs. DCD (recipient warm ischaemia time-WIT, AST peak). Furthermore, we identified a cut-off of 37 minutes in recipient-WIT as predictive of AKI stage 3 in recipients from DCD.
2017
International Liver Congress / 52nd Annual Meeting of the European-Association-for-the-Study-of-the-Liver
04 Pubblicazione in atti di convegno::04d Abstract in atti di convegno
Ischaemic-reperfusion injury and different risk factors for acute kidney injury in donation after circulatory death liver transplantation. UK single centre study / Umbro, I.; Tinti, F.; Evison, F.; Kalisvaart, M.; Sharif, A.; Gunson, B.; Mitterhofer, A. P.; Ferguson, J.; Muiesan, P.. - In: JOURNAL OF HEPATOLOGY. - ISSN 0168-8278. - 66:Supplement 1(2017), pp. S183-S183. (Intervento presentato al convegno International Liver Congress / 52nd Annual Meeting of the European-Association-for-the-Study-of-the-Liver tenutosi a Amsterdam, NETHERLANDS) [10.1016/S0168-8278(17)30654-2].
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1350761
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