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Predictive role of vitamin B12 in acute kidney injury in living donor liver transplantation: a propensity score matching analysis.

ABSTRACT: OBJECTIVES:We examine the association between vitamin B12 level and risk for acute kidney injury (AKI) in patients undergoing living donor liver transplantation (LDLT). DESIGN:Retrospective observational cohort study. SETTING:University hospital, from January 2009 to December 2018. PARTICIPANTS:A total of 591 patients who underwent elective LDLT were analysed in this study. Those with a preoperative history of kidney dysfunction, vitamin B12 supplementation due to alcoholism, low vitamin B12 (<200?pg/mL) or missing laboratory data were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES:The population was classified into AKI and non-AKI groups according to Kidney Disease Improving Global Outcomes (KDIGO) criteria, and associations between perioperative factors and AKI were analysed. After 1:1 propensity score (PS) matching, the association between high vitamin B12 (>900?pg/mL) and postoperative AKI was evaluated. RESULTS:Preoperative vitamin B12 was higher in the AKI group. Potentially significant perioperative factors from univariate analyses were entered into multivariate analyses, including preoperative factors (vitamin B12, diabetes), intraoperative factors (hourly urine output) and donor graft fatty change in LDLT patients. PS matching analyses with adjustment using PS revealed that high serum vitamin B12 (>900?pg/mL) was associated with risk for AKI, and the risk was 2.8-fold higher in patients with high vitamin B12 than in those with normal vitamin B12. Higher vitamin B12 was also related to a higher AKI stage. In addition, inflammatory factors (C reactive protein, white blood cells and albumin) were associated with vitamin B12 level. CONCLUSIONS:Our study may improve the accuracy of predicting postoperative AKI by introducing preoperative vitamin B12 into risk assessments for patients undergoing LDLT.

SUBMITTER: Park J

PROVIDER: S-EPMC7668363 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Predictive role of vitamin B<sub>12</sub> in acute kidney injury in living donor liver transplantation: a propensity score matching analysis.

Park Jaesik J Choi Jung Hee JH Choi Ho Joong HJ Hong Sang Hyun SH Park Chul Soo CS Choi Jong Ho JH Chae Min Suk MS

BMJ open 20201114 11

<h4>Objectives</h4>We examine the association between vitamin B<sub>12</sub> level and risk for acute kidney injury (AKI) in patients undergoing living donor liver transplantation (LDLT).<h4>Design</h4>Retrospective observational cohort study.<h4>Setting</h4>University hospital, from January 2009 to December 2018.<h4>Participants</h4>A total of 591 patients who underwent elective LDLT were analysed in this study. Those with a preoperative history of kidney dysfunction, vitamin B<sub>12</sub> sup ...[more]

PMID: 33191257

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Project description:BackgroundHepatic ischemia-reperfusion injury (HIRI) is largely unavoidable during liver transplantation (LT). Dexmedetomidine (DEX), an α2-adrenergic agonist, exerts a variety of organ-protective effects in pediatric populations. However, evidence remains relatively limited about its hepatoprotective effects in pediatric living-related LT.MethodsA total of 121 pediatric patients undergoing living-related LT from June 2015 to December 2018 in our hospital were enrolled. They were classified into DEX or non-DEX groups according to whether an infusion of DEX was initiated from incision to the end of surgery. Primary outcomes were postoperative liver graft function and the severity of HIRI. Multivariate logistic regression and propensity score matching (PSM) analyses were performed to identify any association.ResultsA 1:1 matching yielded 35 well-balanced pairs. Before matching, no significant difference was found in baseline characteristics between groups except for warm ischemia time, which was longer in the non-DEX group (44 [38-50] vs. 40 [37-44] min, p = 0.017). After matching, the postoperative peak lactic dehydrogenase levels decreased significantly in the DEX group than in the non-DEX group (622 [516-909] vs. 970 [648-1,490] IU/L, p = 0.002). Although there was no statistical significance, a tendency toward a decrease in moderate-to-extreme HIRI rate was noted in the DEX group compared to the non-DEX group (68.6% vs. 82.9%, p = 0.163). Patients in the DEX group also received a significantly larger dosage of epinephrine as postreperfusion syndrome (PRS) treatment (0.28 [0.17-0.32] vs. 0.17 [0.06-0.30] µg/kg, p = 0.010). However, there were no significant differences between groups in PRS and acute kidney injury incidences, mechanical ventilation duration, intensive care unit, and hospital lengths of stay. Multivariate analysis revealed a larger graft-to-recipient weight ratio (odds ratio [OR] 2.657, 95% confidence interval [CI], 1.132-6.239, p = 0.025) and intraoperative DEX administration (OR 0.333, 95% CI, 0.130-0.851, p = 0.022) to be independent predictors of moderate-to-extreme HIRI.ConclusionThis study demonstrated that intraoperative DEX could potentially decrease the risk of HIRI but was associated with a significant increase in epinephrine requirement for PRS in pediatric living-related LT. Further studies, including randomized controlled studies, are warranted to provide more robust evidence.

Dataset Information

Predictive role of vitamin B12 in acute kidney injury in living donor liver transplantation: a propensity score matching analysis.

Publications

Predictive role of vitamin B<sub>12</sub> in acute kidney injury in living donor liver transplantation: a propensity score matching analysis.

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