Karaciğer Nakli Sonrası Akut Böbrek Hasarı: İnsidans, Risk Faktörleri ve Sonuçlar

Year 2023, Volume: 6 Issue: 1, 1 - 11, 30.04.2023

Zeynep Ersoy , Nedim Çekmen , Aycan Özdemirkan , Pınar Zeyneloglu , Adnan Torgay , Mehmet Haberal

https://doi.org/10.36516/jocass.1225060

Abstract

Giriş: Akut böbrek hasarı (ABH) için çok sayıda risk faktörü tanımlanmış olmasına rağmen, bunların kümülatif etkileri belirsizliğini koruyor. Bu çalışmanın amacı, karaciğer transplantasyonu (KT) sonrası hastalarda ABH için perioperatif risk faktörlerini belirlemek ve bu faktörlerin sonuçlar üzerindeki erken klinik değişkenleri kullanarak ABH'yı öngörmektir.
Gereç ve Yöntemler: 2015 ve 2017 yılları arasında KT uygulanan 34 pediatrik hasta ve 31 yetişkinin yer aldığı tek merkezli, retrospektif bir kohort çalışmadır.
Bulgular: 16 (%47) pediatrik hastada KT sonrası ilk haftada ABH meydana geldi ve sırasıyla evre 1, evre 2 ve evre 3 ABH sıklıkları %43.8, %50 ve %6.3 idi. Pediatrik KT hastalarının %18,8'ine renal replasman tedavisi (RRT) başlandı. Pediatrik KT hastalarında preoperatif karaciğer enzimleri ve karaciğer yetmezliği etiyolojisi ABH'yi etkileyen en önemli faktörlerdir. ABH 15 (%48) yetişkin hastada KT sonrası ilk haftada meydana geldi ve sırasıyla %43, %21 ve %21'lik evre 1, evre 2 ve evre 3 AKI oluştu. Erişkin KT hastalarının %43'ünde RRT gereksinimi görüldü. Ameliyat öncesi böbrek fonksiyon bozukluğu olan hasta sayısı (%20-80, p=.047) ve mortalite oranları (%6-31, p=.047) açısından da iki grup arasında istatistiksel fark vardı. KT sonrası ABH gelişen erişkin hastalar, KT sonrası ABH gelişmeyenlerle karşılaştırıldığında, bu hastalarda anlamlı olarak daha yüksek serum kreatinin (sCr) seviyeleri vardı (1,9±1,9 mg/dL'ye karşı 0,7±0,1 mg /dL, p=.013), daha düşük miktarlarda kristalloid verilmişti (73±32 mL/kg- 106±33 mL/kg, p=.018) ve intraoperatif olarak daha düşük idrar çıkışları (UO) (11±9 mL/ kg'a karşı 20±9 mL/kg, p=.047) olduğu tespit edildi. KT sonrası ABH olan yetişkin hastalarda daha yüksek bir mortalite oranı vardı (%89'a karşı %11, p=.003).
Sonuç: Çalışmamızın sonuçları, preoperatif değerlendirme, intraoperatif ve postoperatif yakın takip, dikkatli anestezi yönetimi sağlanmasının önemini vurgulamak ve KT sonrası ABH'nin erken başlaması ile ilişkili potansiyel risk faktörleri konusunda farkındalığın artmasına katkıda bulunmaktadır.

Keywords

Karaciğer transplantasyonu, akut böbrek hasarı, perioperatif yönetim, risk faktörleri, sonuçlar

Supporting Institution

Yok

Project Number

KA22/228

Thanks

Değerlendirme için dergi editör ekibine teşekkür ediyoruz.

Acute Kidney Injury After Liver Transplantation: Incidence, Risk Factors, and Outcomes

Abstract

Introduction: Although numerous risk factors for acute kidney injury (AKI) have been identified, their cumulative impact remains unclear. This study aimed to identify perioperative risk factors for early post-transplant AKI on patients and outcomes and to predict AKI using clinical variables.
Material and Methods: A single-center, retrospective cohort study involving 34 pediatric patients and 31 adults who underwent LT between 2015 and 2017.
Results: AKI occurred in 16 (47%) pediatric patients during the first-week post-LT with stage 1, stage 2, and stage 3 AKI frequencies of 43.8, 50, and 6.3%, respectively. Renal replacement therapy (RRT) was initiated in 18.8% of pediatric LT patients. Preoperative liver enzymes and the etiology of liver failure are the most critical factors affecting AKI in pediatric LT patients. AKI occurred in 15 (48%) adult patients during the first-week post-LT with stage 1, stage 2, and stage 3 AKI frequencies of 43%, 21%, and 21%, respectively. The requirement for RRT was seen in 43% of adult LT patients. There were also statistical differences between the two groups regarding the number of patients with preoperative kidney dysfunction (20-80%, p=.047) and mortality rates (6-31 %, p=.047). In adult patients who developed post-LT AKI compared with those who did not develop post-LT AKI, they had significantly higher levels of serum creatinine (sCr) (1.9±1.9 mg/dL vs. 0.7±0.1 mg/dL, p=.013), were given lower amounts of crystalloids (73±32 mL/kg vs. 106±33 mL/kg, p=.018) and had lower urine output (UO) intraoperatively (11±9 mL/kg vs. 20±9 mL/kg, p=.047). There was a higher mortality rate in adult patients with post-LT AKI (89 vs. 11%, p=.003).
Conclusion: The results of our study contribute to raising awareness of the potential risk factors associated with preoperative evaluation, intraoperative and postoperative close follow-up, careful anesthesia management, and early onset of post-LT AKI.

Keywords

Liver transplantation, acute kidney injury, perioperative management, risk factors, outcomes

Project Number

KA22/228

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