Predictive factors of the development of acute renal failure in the immediate post-hepatic transplant period

Introduction

The incidence of acute renal failure (ARF) in the immediate post-hepatic transplant period is around 12–51%. The aetiology is multiple. The ARF raises mortality of the hepatic transplant up to 50% according to some series. That is why it is so important to determine the factors that contribute to the development of ARF and to try to correct these as quickly as possible.

Materials and methods

We studied 102 patients who had received an orthopic liver transplant (OLT) from a donor subject during the past 5 years. We performed a follow-up of 6 months with the aim of determining which factors are implicated in the development of renal dysfunction in the immediate post-transplant period. We analyzed characteristics of the donor, reasons for transplantation, Child-Pugh stage, and cold ischemic time, number of blood concentrates transfused during surgery, serology and biochemical parameters of renal and liver function before transplantation and at time of admittance to the ICU. We used univariable and multivariable studies.

Results

We studied 102 patients that had received an OLT, of which 67.6% were male. The mean age was 52.58 years, and 52.08 years for the donors. The most frequent cause of brain death was due to CVA. The most frequent aetiology of OLT was alcoholic cirrhosis. Of the serologies, 33.3% were positive for HCV and 72.3% for CMV. We found series of factors that influence the development of ARF in the immediate post-transplant period: patients with a negative serology for CMV (P = 0.005), patients with hepatorenal syndrome before the transplantation (P = 0.001), blood concentrates transfused during surgery (3.98 ± 3.84 in the patients who did not develop ARF and 10.23 ± 8.28 in those who did develop ARF) (P = 0.000), Child-Pugh stage (P = 0.000), levels of urea and creatinine at the moment of admittance to the ICU (P = 0.000 and P = 0.05, respectively), albumin level (P = 0.002), total bilirubin level (P = 0.001), conjugated bilirubin (P = 0.000) and the level of total proteins (P = 0.000).

Conclusion

The development of ARF in the immediate post-transplant period is more frequent in those patients with hepatorenal syndrome before transplantation, with stage C of Child-Pugh, with complications during surgery with the need for blood transfusions and in those with low serum albumin and high levels of bilirubin in the immediate post-transplant period.