Incidence and Factors Associated with Perioperative Adverse Event and Acute Kidney Injury after Liver Transplantation in Srinagarind Hospital

Abstract

Background: Liver transplantation (LT), a standard treatment for patients with end stage liver disease. Acute kidney injury (AKI) is a common complication after LT and may affect long term outcomes. Perioperative adverse events can be associated with postoperative AKI. This study aimed to know the incidence and factors associated with adverse events and postoperative AKI in patients undergoing LT. Methods: Medical records of all patients aged 18 years and over undergone LT during the 13-year study period (February 2006 to May 2018) were reviewed. Preoperative patients’conditions, anesthetic management including intraoperative adverse events and postoperative AKI defined by the Acute Kidney Injury Network (AKIN) consensus criteria were recorded. Multivariable analysis was used to find association between perioperative factors and postoperative AKI. Results: There were 79 patients were analyzed. Most common perioperative adverse event was hypotension (81.0%). Postoperative AKI were found 21.5%. Postoperative deaths were 7.6%. The patients with and without AKI were different in terms of preoperative level of hematocrit (P=0.036), Child-Pugh score (P=0.010), amount of blood component used (PRC and FFP, P=0.010 and 0.030 respectively) and dopamine used (P<0.001). Postoperative death and hospital stay were not different in both groups. Multivariable analysis showed that only Child-Pugh Class C was associated with postoperative AKI. (adjusted OR 13.48, 95% CI 2.31-78.61). Conclusions: Intraoperative hypothermia and hypotension were common in the patients underwent liver transplantation. Incidence of postoperative acute kidney injury is 21.5% and associated with the patient’s Child-Pugh Class C.