Hepatic ischemia/reperfusion injury associates with acute kidney injury in liver transplantation: Prospective cohort study

Abstract

Solid clinical prospective studies investigating the association between hepatic ischemia reperfusion injury and acute kidney injury after liver transplantation are missing. Hepatic ischemia reperfusion injury -reflected by transaminase release- induces acute kidney injury in rodents and retrospective studies suggest a similar association in man. This prospective cohort study determined risk factors for acute kidney injury in 80 adult liver-only recipients. Acute kidney injury -defined by RIFLE-criteria- developed in 21 (26%) recipients at 12 hours postreperfusion [inter quartile range: 6 hours-postoperative day 1]; 13 progressed from “Risk” to “Injury”; 5 to “Failure”. In acute kidney injury patients, creatinine increased during liver transplantation and was higher vs. baseline at 6h to postoperative day 4 while peroperative creatinine remained stable in those without acute kidney injury. Plasma heart-fatty acid binding protein was higher 12 hours postreperfusion in acute kidney injury patients, though urinary kidney-injury-molecule-1 and neutrophil gelatinase associated lipocalin were similar between those with or without acute kidney injury. Peak aspartate aminotransferase, occurring at 6 hours, was the only independent risk factor for acute kidney injury [adjusted odds ratio 2.42 (1.24-4.91)]. Early allograft dysfunction occurred more frequently in acute kidney injury-patients and intensive care and hospital stays were longer. Patient survival at 1y was 90% in those with acute kidney injury vs. 98% in those without acute kidney injury. Chronic kidney disease stage ≥2 at 1y was more frequent in patients who had had acute kidney injury (89% vs. 58%, respectively). Conclusion: Acute kidney injury is initiated early after liver reperfusion and its association with peak aspartate aminotransferase suggests hepatic ischemia reperfusion injury as a determinant. Identifying operating mechanisms is critical to target interventions and reduce associated morbidity.