218.6 Incidence and predictors of acute kidney injury immediately post liver transplantation in pediatric patients
Sunday May 05, 2019 from 13:45 to 14:45
Seymour Room
Presenter

Daniela Damian, United States

Clinical Assistant Professor

Aneshesiology

Children's Hospital of Pittsburgh

Abstract

Incidence and predictors of acute kidney injury immediately post liver transplantation in pediatric patients

Lindsay Rutland1, Mihaela Visoiu1, Kyle A Soltys2, Daniela Damian1.

1Anesthesiology, Children's Hospital of Pittsburgh, Pittsburgh, PA, United States; 2Surgery, Children's Hospital of Pittsburgh, Pittsburgh, PA, United States

Introduction: Incidence of perioperative acute kidney injury (AKI) after pediatric liver transplantation was reported to be as high as 66% with significant risk for chronic kidney disease (2). Our goal was to identify the incidence of AKI in the first 48h postoperatively and identify the potential pre and intra-operative risk factors. 

Method: We performed a retrospective cohort analysis of 205 consecutive patients undergoing liver transplantation from June 23, 2010 to June 6, 2017 at Children’s Hospital of Pittsburgh of UPMC. Of the initial 205 patients reviewed, 7 patients were eliminated due to incomplete records. We divided our patients into two groups based on AKI criteria, defined as an absolute increase of 0.3 mg/dl in creatinine value in the first 48 h after liver transplantation. (1)  We compared the difference in pertinent pre and intra-operative variables between the two groups.  Data are presented as means ± standard deviations, median with IQR or number with percentages as appropriate. Statistical significance was determined by a p < 0.05. Multivariable logistic regression was used to determine predictive outcomes for AKI after pediatric liver transplantation. 

Results: In our cohort the incidence of AKI was 15.7%. The preoperative and intraoperative variables are delineated in Table 1. Based on the logistic regression model in our patient population, age (OR 1.19 [95% CI 1.11-1.26]), preoperative INR (OR 1.71 [ 95% CI 1.13 - 2.59]) and platelets transfusion (OR 1.05 [95% CI 1.007 - 1.101]), where predictive risk factors for AKI immediately after liver transplantation. During the current admission, no deaths were reported. 

Conclusion: We found that AKI was significantly higher in patients of an older age, higher weight, received a whole liver. Those patients also had significantly lower platelets count and higher creatinine preoperatively, and their surgical procedures were longer. The re-do transplantation was also a risk factor. Less volume of crystalloids and albumine 5%, as well as increased variability of blood products administration led to higher incidence of AKI. The final predictive risk model for AKI in pediatric liver transplants in our population included only age, preoperative INR and platelets transfusion.

References:

[1] Kdigo AKI. Work Group: KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2012;2:1–138.
[2] Williams C, Borges K, Banh T, et al. Patterns of kidney injury in pediatric nonkidney solid organ transplant recipients. Am J Transplant 2018


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