Incidence of renal failure following orthotopic liver transplantation is lower in the Asian population

Introduction

Renal failure is reported as a frequent complication following orthotopic liver transplantation (OLT) and is associated with a higher morbidity and mortality [1]. Acute kidney injury and the need for renal replacement therapy (RRT) are known to be generally greater in the Asian population for a number of proposed reasons, such as higher incidence of diabetes mellitus and hypertension. In our study the incidence of renal failure and the need for RRT in the early postoperative period following OLT was actually lower in this group.

Methods

A retrospective case-note review was undertaken on 348 consecutive elective OLTs performed in the period 2000–2007 at our institution. The primary outcome was the requirement for RRT and renal impairment as per the RIFLE and AKIN criteria. Patients on RRT pretransplant, acute hepatic failure, regraft and combined organ transplant were excluded.

Results

Two hundred and seventy-one patients fulfilled the inclusion criteria, of which 45 (17%) were of Asian ethnicity. A total of 32 patients required RRT in the early postoperative period, of which only three (9.4%) were Asian. The change in serum creatinine in the first 48 hours was also examined and is presented in Table 1. The baseline pretransplant serum creatinine was similar between the groups: The median serum creatinine was 86 μmol/l for both the Asian (range 60–179) and non-Asian groups (range 34–264).

Table 1 Change in serum creatinine following OLT as per RIFLE/AKIN criteria

Conclusion

The burden of RRT following liver transplantation was less in the Asian population. Examination of perioperative serum creatinine showed that the Asian group actually suffered mild renal dysfunction to a greater extent (42% vs 34%) but did not progress to 'failure' stage as often as non-Asians (7% vs 16%, P < 0.05). The reason for this reversal may be partly due to far fewer Asian transplant recipients with alcoholic liver disease, a known predisposing risk factor.