Evaluation of acute kidney injury in patients with liver transplantation

The aim of this single-center, retrospective study was to investigate the frequency and risk factors of acute kidney injury after liver transplantation. 100 patients were included in the study. Patients younger than 18 years of age, patients with cadaveric liver transplantation, and patients whose data could not be accessed were not included in our study. Age, gender, weight, comorbid diseases, ASA score, MELD score, Child Pugh score, history of HES, history of esophageal variceal bleeding, presence of ascites, number of transplants, etiology of liver failure were recorded. In the preoperative period, BUN, creatinine, GFR, albumin, total bilirubin, direct bilirubin, AST, ALT, INR, APTT, serum sodium, serum potassium, serum chlorine and serum calcium values of the patients were recorded from the hospital system. These data were recorded by looking at the postoperative day 1 and day 7 again. The amount of crystalloid, albumin and other colloid fluid given to the patients during the intraoperative period, erythrocyte suspension, thrombocyte suspension, fresh frozen plasma unit, intraoperative urine output and anesthesia times were recorded. It was recorded whether the patients took diuretics during the intraoperative period, which diuretic drug was used if they did, and if they took an inotropic agent, which inotropic agent was used. It was checked whether the patients received renal replacement therapy in the postoperative period, whether they were operated again, the duration of postoperative intensive care stay and hospital stay. The 90-day mortality of the patients was evaluated. Whether the patients had acute kidney injury or not was determined according to the KDIGO (The Kidney Disease: Improving Global Outcomes) classification published in 2012. In our study, high ASA score, history of HES, high INR, AST, ALT, total and direct bilirubin values in the preoperative period were found to be risk factors for the development of AKI in the postoperative period. It has been observed that patients with AKI have a longer intensive care unit stay and an increased 90-day mortality. In the postoperative period, patients with low hemoglobin and thrombocyte levels, high total bilirubin and direct bilirubin values, and longer INR and APTT were more likely to have AKI. Patients with intraoperative ≥15 units of ES replacement are at risk for the development of AKI in the postoperative period.