Acute kidney injury after living-related liver transplantation in infants with biliary atresia: A retrospective study

Abstract

Although acute kidney injury (AKI) is a frequent postoperative complication after liver transplantation, renal function following living-related liver transplantation (LRLT) in infants remains understudied. The aim of this study was to identify the prevalence of AKI and the impact of AKI on outcomes in infant recipients with biliary atresia. We retrospectively reviewed infants who underwent LRLT surgery between January 2018 and January 2021. The primary outcome was the risk of postoperative AKI occurrence in the first 7 postoperative days. A multivariate regression analysis model was used to investigate risk factors for AKI, and the incidence and impacts of AKI on outcomes were analyzed. A total of 98 patients were included in the analysis. AKI occurred in 59 patients (60.2%) within 7 days after surgery. Logistic regression analysis revealed that preoperative transfusion (p < 0.05) and lower serum creatinine (SCr) (p < 0.05) were independent risk factors for AKI. The incidence of serious complications was significantly higher in the AKI group than in the non-AKI group (p < 0.05). The postoperative mechanical ventilation time (p < 0.05) and hospital stay (p = 0.019) were significantly longer in the AKI group. There was no evidence of chronic kidney disease (CKD) in any surviving infants within 1 year after surgery. In conclusion, AKI is common in infant LRLT (60.2%), and preoperative transfusion and lower SCr levels were independently associated with AKI. AKI may be associated with the incidence of serious complications, prolonged use of ventilators, and hospital stays. No CKD occurred within 1 year.

Keywords

acute kidney injury / biliary atresia / infants / liver transplantation / pediatric

References

[1] Kehar M, Parekh RS, Stunguris J, et al. Superior outcomes and reduced wait times in pediatric recipients of living donor liver transplantation. Transplant Direct. 2019;5(3):e430.

[2] Adam R, Karam V, Cailliez V, et al. 2018 Annual report of the European Liver Transplant Registry (ELTR)-50-year evolution of liver transplantation. Transpl Int. 2018;31(12):1293-1317.

[3] Wall P, Xu D, Zhang J, et al. Liver transplantation for biliary atresia: a nationwide investigation from 1996 to 2013 in mainland China. Pediatr Transplant. 2016;20(8):1051-1059.

[4] Kim JM, Kim KM, Yi NJ, et al. Pediatric liver transplantation outcomes in Korea. J Kor Med Sci. 2013;28(1):42-47.

[5] Dong V, Nadim MK, Karvellas CJ. Post-liver transplant acute kidney injury. Liver Transplant. 2021;27(11):1653-1664.

[6] Zhou J, Zhang X, Lyu L, Ma X, Miao G, Chu H. Modifiable risk factors of acute kidney injury after liver transplantation: a systematic review and meta-analysis. BMC Nephrol. 2021;22:1-14.

[7] Ferah O, Akbulut A, Acik ME, et al. Acute kidney injury after pediatric liver transplantation. In: Transplantation Proceedings. Vol 51(7). Elsevier; 2019:2486-2491.

[8] Allen AM, Kim WR, Therneau TM, Larson JJ, Heimbach JK, Rule AD. Chronic kidney disease and associated mortality after liver transplantation–a time-dependent analysis using measured glomerular filtration rate. J Hepatol. 2014;61(2):286-292.

[9] Sahinturk H, Ozdemirkan A, Zeyneloglu P, Gedik E, Pirat A, Haberal M. Early postoperative acute kidney injury among pediatric liver transplant recipients. Exp Clin Transplant. 2019;19(7):659-663.

[10] Hamada M, Matsukawa S, Shimizu S, Kai S, Mizota T. Acute kidney injury after pediatric liver transplantation: incidence, risk factors, and association with outcome. J Anesth. 2017;31(5):758-763.

[11] Silver LJ, Pan S, Bucuvalas JC, et al. Acute kidney injury following pediatric liver transplant. J Intensive Care Med. 2022;37(1):107-113.

[12] Alobaidi R, Morgan C, Goldstein SL, Bagshaw SM. Population based epidemiology and outcomes of acute kidney injury in critically ill children. Pediatr Crit Care Med. 2020;21(1):143-149.

[13] Selewski DT, Cornell TT, Heung M, et al. Validation of the KDIGO acute kidney injury criteria in a pediatric critical care population. Intensive Care Med. 2014;40(10):1481-1488.

[14] Nahum E, Kadmon G, Kaplan E, et al. Prevalence of acute kidney injury after liver transplantation in children: comparison of the pRIFLE, AKIN, and KDIGO criteria using corrected serum creatinine. J Crit Care. 2019;50:275-279.

[15] Kalisvaart M, de Haan JE, Hesselink DA, et al. The postreperfusion syndrome is associated with acute kidney injury following donation after brain death liver transplantation. Transpl Int. 2017;30(7):660-669.

[16] Lal BB, Alam S, Sood V, Rawat D, Khanna R. Profile, risk factors and outcome of acute kidney injury in paediatric acute-on-chronic liver failure. Liver Int. 2018;38(10):1777-1784.

[17] Filler G, Bhayana V, Schott C, Díaz-González de Ferris ME. How should we assess renal function in neonates and infants?Acta Paediatr. 2021;110(3):773-780.

[18] Schwartz GJ, Work DF. Measurement and estimation of GFR in children and adolescents. Clin J Am Soc Nephrol. 2009;4(11):1832-1843.

[19] Gattineni J, Baum M. Developmental changes in renal tubular transport-an overview. Pediatr Nephrol. 2015;30(12):2085-2098.

[20] Karkouti K. Transfusion and risk of acute kidney injury in cardiac surgery. Br J Anaesth. 2012;109(suppl 1):i29-i38.

[21] Kim WH, Oh HW, Yang SM, et al. Intraoperative hemodynamic parameters and acute kidney injury after living donor liver transplantation. Transplantation. 2019;103(9):1877-1886.

[22] Wei Y, Zhang L, Lin H, et al. Factors related to post–liver transplantation acute renal failure. In: Transplantation Proceedings. Vol 38(9) Elsevier; 2006:2982-2984.

[23] IJtsma AJC, van der Hilst CS, de Boer MT, et al. The clinical relevance of the anhepatic phase during liver transplantation. Liver Transplant. 2009;15(9):1050-1055.

[24] Jochmans I, Meurisse N, Neyrinck A, Verhaegen M, Monbaliu D, Pirenne J. Hepatic ischemia/reperfusion injury associates with acute kidney injury in liver transplantation: prospective cohort study. Liver Transplant. 2017;23(5):634-644.

[25] Lacquaniti A, Campo S, Casuscelli Di Tocco T, et al. Acute and chronic kidney disease after pediatric liver transplantation: an underestimated problem. Clin Transplant. 2020;34(11):e14082.

[26] Klaus F, da Silva CK, Meinerz G, et al. Acute kidney injury after liver transplantation: incidence and mortality. In: Transplantation Proceedings. Vol 46(6). Elsevier; 2014:1819-1821.

[27] Durand F, Francoz C, Asrani SK, et al. Acute kidney injury after liver transplantation. Transplantation. 2018;102(10):1636-1649.

[28] Umbro I, Tinti F, Scalera I, et al. Acute kidney injury and post-reperfusion syndrome in liver transplantation. World J Gastroenterol. 2016;22(42):9314-9323.

[29] Lim SY, Wang R, Tan DJH, et al. A meta-analysis of the cumulative incidence, risk factors, and clinical outcomes associated with chronic kidney disease after liver transplantation. Transpl Int. 2021;34(12):2524-2533.

[30] Herzog D, Martin S, Turpin S, Alvarez F. Normal glomerular filtration rate in long-term follow-up of children after orthotopic liver transplantation. Transplantation. 2006;81(5):672-677.

[31] Ojo AO, Held PJ, Port FK, et al. Chronic renal failure after transplantation of a non-renal organ. N Engl J Med. 2003;349(10):931-940.

[32] Kivelä JM, Räisänen-Sokolowski A, Pakarinen MP, et al. Long-term renal function in children after liver transplantation. Transplantation. 2011;91(1):115-120.

[33] Harambat J, Ranchin B, Dubourg L, et al. Renal function in pediatric liver transplantation: a long-term follow-up study. Transplantation. 2008;86(8):1028-1034.

[34] Mention K, Lahoche-Manucci A, Bonnevalle M, et al. Renal function outcome in pediatric liver transplant recipients. Pediatr Transplant. 2005;9(2):201-207.

RIGHTS & PERMISSIONS

2023 2023 The Authors. Pediatric Discovery published by John Wiley & Sons Australia, Ltd on behalf of Children's Hospital of Chongqing Medical University.