Postreperfusion Syndrome in Liver Transplant: A Risk Factor for Acute Kidney Failure: A Retrospective Analysis

Area of Science:

• Transplantation Medicine
• Nephrology
• Hepatology

Background:

• Postreperfusion syndrome (PRS) is a major complication of liver transplantation, associated with hemodynamic instability.
• The relationship between PRS and acute kidney failure (AKF) remains debated, despite PRS's known impact on mortality and complications.

Purpose of the Study:

• To investigate the incidence of PRS in liver transplant recipients.
• To analyze the association between PRS and the development and severity of AKF.
• To evaluate the impact of PRS on kidney function post-liver transplant.

Main Methods:

• Retrospective observational study of 551 deceased-donor liver graft recipients from January 2002 to December 2018.
• Analysis of PRS incidence and correlation with AKF development, including kidney replacement therapy and AKI stages (1-3).
• Multivariate analysis adjusted for factors like anhepatic phase duration, donor age, MELD score, ascites, and reintervention.

Main Results:

• PRS was recorded in 23.6% of patients (n=130).
• The overall incidence of AKF was 61.5%, with 32.7% requiring kidney replacement therapy.
• Patients with PRS had a significantly higher incidence of AKF (75.4% vs. 57.2%) and PRS was independently associated with AKF (OR 2.18, P=.003).
• Even after implementing improved surgical techniques and delayed immunosuppression, PRS remained a significant risk factor for AKF (OR 3.78, P<.001).

Conclusions:

• Postreperfusion syndrome is a significant independent risk factor for acute kidney failure following liver transplantation.
• Despite advancements in surgical techniques and immunosuppression protocols, PRS continues to negatively impact kidney function.
• Further research into mitigating PRS is crucial for improving post-liver transplant outcomes.