[Liver transplantation and peri-operative changes to renal function]

Area of Science:

• Nephrology
• Hepatology
• Transplantation Surgery

Context:

• Orthotopic liver transplantation (OLT) is a complex procedure with significant implications for renal function.
• Understanding perioperative renal changes is crucial for managing post-transplant outcomes.
• Acute kidney injury (AKI) is a common complication following OLT.

Purpose:

• To analyze perioperative renal function changes during OLT.
• To identify risk factors associated with the need for renal replacement therapy (RRT) in the first week post-OLT.
• To assess long-term renal function recovery after OLT.

Summary:

• OLT leads to significant alterations in glomerular and tubular renal functions, evidenced by changes in serum and urine creatinine and urea.
• Perioperative proteinuria, particularly the urinary protein-to-creatinine ratio (Uprot/Ucr), emerged as a sensitive marker for renal injury during OLT.
• Risk factors for AKI requiring RRT included higher APACHE scores, BMI, preoperative renal parameters, hepatorenal syndrome, intraoperative instability, and graft dysfunction.

Impact:

• Early postoperative RRT for AKI following OLT does not preclude long-term renal function recovery.
• Identifying at-risk patients and monitoring perioperative proteinuria can aid in timely intervention and management.
• This study provides valuable insights for optimizing patient care and improving outcomes in OLT recipients.