Abstract
The aim of the study: Was to analyze in detail perioperative changes of renal function during orthotopic liver transplantation (OLT) and to identify risk factors, that were associated with the need of renal replacement therapy (RRT) during the fi rst week after liver transplantation. Methods: Prospective study of 50 consecutive patients undergoing OLT was performed.
Selected laboratory and clinical parameters were monitored prior to the procedure, after reperfusion, at the end of the procedure, and at 12 hours after the procedure. In the fi rst post-transplant week, necessity to use RRT in the presence of acute kidney injury was monitored and the analysis of risk factors for the need for RRT was performed.
Patient survival, graft function, need for dialysis and selected laboratory parameters were assessed at one year post-transplant. Results: During OLT, there was an increase in Scr and Surea, which persisted as late as 12 hours post-transplant.
There was a decrease in Ucr and Uurea and an increase in SNa and SK. During the procedure any increase in Scyst were observed, increase the values were recorded 12 hours after surgery.
Sbili level decreased. There was a rise in the urinary levels of total protein, albumin and 2-microglobulin.
Uprot/ Ucr increased signifi cantly after reperfusion, with a peak after the procedure. At 12 hours after the procedure, there was a decrease in Uprot/ Ucr, but the values were still many times higher than those seen preoperatively.
RRT was necessary in 14% cases. Risk factors for acute kidney injury requiring RRT included a higher APACHE score, higher BMI, higher preoperative Scr and Surea, hepatorenal syndrome pretransplant, blood loss and intraoperative hemodynamic instability, postoperative complications and dysfunction of the liver graft.
One year after OLT, there was no difference in followed laboratory values between patients requiring postoperative RRT and others; no patient was treated with dialysis. Conclusion: OLT has a major impact on glomerular and tubular renal functions.
Our data suggest that patients surviving acute renal injury treated with RRT in the early postoperative period have a high chance of restoring renal function. A sensitive marker of renal injury during OLT seems to be perioperative proteinuria.