Clin Transplant 1998 Apr;12(2):123-9

Risk factors for acute renal failure requiring dialysis after liver transplantation

Bilbao I, Charco R, Balsells J, Lazaro JL, Hidalgo E, Llopart L, Murio E,
Margarit C

Abstract
Acute renal failure (ARF) is a common and severe complication after liver
transplantation (LT). The aim of this study was to ascertain the impact of ARF
requiring dialysis in the outcome of LT and to analyze the risk factors leading
to this event in the early post-operative period. From October 1988 to December
1994, 172 LT were performed in 158 patients. Postoperative ARF occurred in 88
transplants (51.1%) during the early postoperative period: mild ARF was found in
46 (serum creatinine 1.5-3 mg/dl), moderate ARF in 12 (serum creatinine > 3
mg/dl) and severe ARF in 30 (serum creatinine > 3 mg/dl with dialysis
requirement). Preoperative, intraoperative, and postoperative variables were
studied, comparing patients presenting severe ARF with the remaining patients.
Postoperative mortality in the dialysed group was much higher than in the
non-dialysis group (50% vs. 13.4%)(p < 0.001) and 1-yr actuarial graft survival
was 73.4% for the non-dialysed group compared with 40.9% for the dialysed group
(p < 0.05). Among 38 variables investigated, only two factors had independent
prognostic value in multivariate analysis: preoperative serum creatinine > 1.5
mg/dl (OR = 4.4, p = 0.006) and graft dysfunction grades III-IV (OR = 8.9, p =
0.001). In conclusion, ARF is a severe complication post-LT; its appearance
could be predicted in patients with pre-transplant renal dysfunction, severe
graft dysfunction, or both. However, in many cases renal function may revert to
normal if treated aggressively with early dialysis support