Post liver transplantation renal impairment: experience with the first 100 cases in a single center in Mongolia
Batsaikhan Batsuuri1,5, Fidel Lopez-Verdugo2,6, Bat-Ireedui Badarch1, Angel Flores Huidobro Martinez2,6, Sarnai Erdene5, Akanksha Mishra2, Ganzorig Batchuluun5, Jade Nunez2, Batsaikhan Bat-Erdene1, Jonathan Nellermoe2, Sudha P. Jayaraman2, Ariunaa Togtokh4, Raymond R. Price2, Shiirevnyamba Avirmed5, Manuel I. Rodriguez-Davalos2,6, Sung-Gyu Lee3, Sergelen Orgoi1,5.
1Transplant, First Central Hospital of Mongolia , Ulaanbaatar, Mongolia; 2School of Medicine - Center for Global Surgery, University of Utah, Salt Lake City , UT, United States; 3Liver Transplant, Asan Medical Center, Seoul, Korea; 4Nephrology, Mongolian National University of Medical Science, Ulaanbaatar, Mongolia; 5Surgery, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia; 6Transplantation, Intermountain Healthcare, Salt Lake City, UT, United States
Introduction: Renal impairment is multifactorial complication of liver transplantation (LT) with a variable prevalence that depends on pretransplant comorbidities, degree and cause of ESLD, intra and postoperative variables. Predisposing factors and incidence haven’t been studied in emerging transplant centers. In this study we aimed to identify risk factors and incidence of post-LT renal impairment in the first 100 LT cases in an emerging transplant center.
Methods: This was a single center retrospective case-control study of 100 adult patients who underwent LT from September 2011 to September 2020. Renal impairment was defined as a KDIGO stage III or IV. Creatinine and GFR were measured pre-transplantation, intraoperatively and post LT. Cases and controls were compared to identify risk factors. Evaluated variables included demographics, etiology of liver disease, MELD preexisting HTN and DM, ischemic time, donor/graft type, intraoperative hemodynamics, use of blood products and postoperative outcomes. Data was collected by survey and statistical processing and analysis was done with Microsoft Excel, SPSS 15.0 software.
Results: Thirty-nine patients in the study had renal impairment, 28 were males (72%) with a mean age of 43y (35-52) with a BMI of 24.7, mean MELD of 14.2 and a class B CPT score in (53.8%). The most common etiology in this group was viral (67%) 10.8% had HTN and preTx diagnosis of DM (compared with 3.7% and 7.4% of the control group). 91% of the total study group were RL LDLT with GRWR, median (IQR) of 1.04 % (0.92-1.21). Tacrolimus+MMF was used in 92% of all cases. (94.8% of study group NS p=0.253). The mean serum creatinine level before liver transplantation was 0.70 ± 0.27 mg/dl, and glomerular filtration rate was 121.6 ± 61.3 ml/min/m2. Average creatinine level of recipients who had renal impairment after liver transplantation was 0.825 ± 0.24 (p= <0.001), and glomerular filtration rate was 111 ± 36.3 ml/min/m2 (p=<0.001). Other variables, like diagnosis, degree of disease, preexisting comorbidities, donor/graft type, intraoperative hemodynamics immunosuppression and postoperative outcomes were not statistically significant.
Conclusions: Our data shows that there is a statistically significant correlation between high pre-transplant serum creatinine levels, low glomerular filtration rate and post-transplant renal impairment. This correlates with experienced centers results, showing that emerging transplant centers have similar rates, understanding that our MELD scores are on average lower than larger series. There was a higher number of patients in the study group with HTN and DM, that said this was not statistically significant. The main limitation of the study is related to sample size but as our rate of LT continues to grow significantly every year, we will continue to asses variables and modify these factors to improve the rate of kidney dysfunction.
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