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Role of serum levels of intraoperative brain natriuretic peptide for predicting acute kidney injury in living donor liver transplantation.

ABSTRACT: BACKGROUND:Patients with end-stage liver disease frequently experience acute kidney injury (AKI) after living donor liver transplantation (LDLT). Serum levels of brain natriuretic peptide (BNP) have increasingly been accepted as a predictor of AKI in clinical settings. This study investigated the predictive role of intraoperative BNP levels in the early development of AKI after LDLT. PATIENTS AND METHODS:Adult patients (?19 years old) who had undergone elective LDLT from January 2011 to December 2017 were classified into the non-AKI and AKI groups according to the Kidney Disease: Improving Global Outcomes criteria. Serum levels of BNP were measured three times in the preanhepatic, anhepatic, and neohepatic phases. Perioperative data in recipients and donors were analyzed retrospectively. RESULTS:Sixty-one patients (22.4%) suffered from AKI immediately after LDLT. Severity according to AKI stage was as follows: 28 patients in stage 1 (10.3%), 18 patients in stage 2 (6.6%), and 15 patients in stage 3 (5.5%). In the neohepatic phase, both BNP levels and proportions of patients with high BNP levels (?100 pg/mL) were higher in the AKI group than in the non-AKI group. Only BNP levels in the non-AKI and AKI stage 1 groups significantly decreased from the preanhepatic phase to the neohepatic phase; those in AKI stages 2 and 3 groups did not. In particular, BNP levels of all AKI stage 3 patients increased to more than 100 pg/mL, and the proportion of patients with high levels also increased significantly through the surgical phases in the AKI stage 3 group. In multivariate analyses, BNP levels in the neohepatic phase were significantly associated with early development of AKI after LDLT, as well as the total amount of packed red blood cells in transfusions and total duration of graft ischemia. CONCLUSIONS:Monitoring serum levels of BNP is useful for predicting the early development of AKI after LDLT.

SUBMITTER: Chae MS

PROVIDER: S-EPMC6296541 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Role of serum levels of intraoperative brain natriuretic peptide for predicting acute kidney injury in living donor liver transplantation.

Chae Min Suk MS Park Hyunjoon H Choi Ho Joong HJ Park Misun M Chung Hyun Sik HS Hong Sang Hyun SH Park Chul Soo CS Choi Jong Ho JH Lee Hyung Mook HM

PloS one 20181217 12

<h4>Background</h4>Patients with end-stage liver disease frequently experience acute kidney injury (AKI) after living donor liver transplantation (LDLT). Serum levels of brain natriuretic peptide (BNP) have increasingly been accepted as a predictor of AKI in clinical settings. This study investigated the predictive role of intraoperative BNP levels in the early development of AKI after LDLT.<h4>Patients and methods</h4>Adult patients (≥19 years old) who had undergone elective LDLT from January 2 ...[more]

PMID: 30557393

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Project description:Acute kidney injury (AKI) is a frequent complication after living donor liver transplantation (LDLT), and is associated with increased mortality. However, the association between intraoperative oliguria and the risk of AKI remains uncertain for LDLT. We sought to determine the association between intraoperative oliguria alone and oliguria coupled with hemodynamic derangement and the risk of AKI after LDLT. We evaluated the hemodynamic variables, including mean arterial pressure, cardiac index, and mixed venous oxygen saturation (SvO₂). We reviewed 583 adult patients without baseline renal dysfunction and who did not receive hydroxyethyl starch during surgery. AKI was defined using the Kidney Disease Improving Global Outcomes criteria according to the serum creatinine criteria. Multivariable logistic regression analysis was performed with and without oliguria and oliguria coupled with a decrease in SvO₂. The performance was compared with respect to the area under the receiver operating characteristic curve (AUC). Intraoperative oliguria <0.5 and <0.3 mL/kg/h were significantly associated with the risk of AKI; however, their performance in predicting AKI was poor. The AUC of single predictors increased significantly when oliguria was combined with decreased SvO₂ (AUC 0.72; 95% confidence interval (CI) 0.68⁻0.75 vs. AUC of oliguria alone 0.61; 95% CI 0.56⁻0.61; p < 0.0001; vs. AUC of SvO₂ alone 0.66; 95% CI 0.61⁻0.70; p < 0.0001). Addition of oliguria coupled with SvO₂ reduction also increased the AUC of multivariable prediction (AUC 0.87; 95% CI 0.84⁻0.90 vs. AUC with oliguria 0.73; 95% CI 0.69⁻0.77; p < 0.0001; vs. AUC with neither oliguria nor SvO₂ reduction 0.68; 95% CI 0.64⁻0.72; p < 0.0001). Intraoperative oliguria coupled with a decrease in SvO₂ may suggest the risk of AKI after LDLT more reliably than oliguria alone or decrease in SvO₂ alone. Intraoperative oliguria should be interpreted in conjunction with SvO₂ to predict AKI in patients with normal preoperative renal function and who did not receive hydroxyethyl starch during surgery.

Dataset Information

Role of serum levels of intraoperative brain natriuretic peptide for predicting acute kidney injury in living donor liver transplantation.

Publications

Role of serum levels of intraoperative brain natriuretic peptide for predicting acute kidney injury in living donor liver transplantation.

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