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Impact of the etiology of acute kidney injury on outcomes following liver transplantation: acute tubular necrosis versus hepatorenal syndrome.
Nadim, Mitra K; Genyk, Yuri S; Tokin, Chris; Fieber, Jenny; Ananthapanyasut, Wanwarat; Ye, Wei; Selby, Rick.
Afiliação
  • Nadim MK; Division of Nephrology, Department of Medicine, Los Angeles, CA 90033, USA. nadim@usc.edu
Liver Transpl ; 18(5): 539-48, 2012 May.
Article em En | MEDLINE | ID: mdl-22250075
ABSTRACT
Acute kidney injury (AKI) at the time of liver transplantation (LT) has been associated with increased morbidity and mortality. In patients with potentially reversible renal dysfunction, predicting whether there will be sufficient return of native kidney function is sometimes difficult. Previous studies have focused mainly on the effect of the severity of renal dysfunction or the duration of pretransplant dialysis on posttransplant outcomes. We performed a retrospective analysis of patients who underwent LT at our center after Model for End-Stage Liver Disease-based allocation so that we could determine the impact of the etiology of AKI [acute tubular necrosis (ATN) versus hepatorenal syndrome (HRS)] on post-LT outcomes. The patients were stratified according to the severity of AKI at the time of LT as described by the Risk, Injury, Failure, Loss, and End-Stage Kidney Disease (RIFLE) classification risk, injury, or failure. The RIFLE failure group was further subdivided according to the etiology of AKI HRS or ATN. The patient survival and renal outcomes 1 and 5 years after LT were significantly worse for those with ATN. At 5 years, the incidence of chronic kidney disease (stage 4 or 5) was statistically higher in the ATN group versus the HRS group (56% versus 16%, P < 0.001). A multivariate analysis revealed that the presence of ATN at the time of LT was the only variable associated with higher mortality 1 year after LT (P < 0.001). Our study is the first to demonstrate that the etiology of AKI has the greatest impact on patient and renal outcomes after LT.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Síndrome Hepatorrenal / Transplante de Fígado / Injúria Renal Aguda / Necrose Tubular Aguda Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Liver Transpl Assunto da revista: GASTROENTEROLOGIA / TRANSPLANTE Ano de publicação: 2012 Tipo de documento: Article País de afiliação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Síndrome Hepatorrenal / Transplante de Fígado / Injúria Renal Aguda / Necrose Tubular Aguda Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Liver Transpl Assunto da revista: GASTROENTEROLOGIA / TRANSPLANTE Ano de publicação: 2012 Tipo de documento: Article País de afiliação: Estados Unidos