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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:Quantifying cell subpopulations in biological fluids aids in diagnosis and understanding of the mechanisms of injury. Although much has been learned from cerebrospinal fluid (CSF) flow cytometry in neuroimmunological disorders, such as multiple sclerosis (MS), previous studies did not contain enough healthy donors (HD) to derive age- and gender-related normative data and sufficient heterogeneity of other inflammatory neurological disease (OIND) controls to identify MS specific changes. The goals of this blinded training and validation study of MS patients and embedded controls, representing 1,240 prospectively acquired paired CSF/blood samples from 588 subjects was (1) to define physiological age-/gender-related changes in CSF cells, (2) to define/validate cellular abnormalities in blood and CSF of untreated MS through disease duration (DD) and determine which are MS-specific, and (3) to compare effect(s) of low-efficacy (i.e., interferon-beta [IFN-beta] and glatiramer acetate [GA]) and high-efficacy drugs (i.e., natalizumab, daclizumab, and ocrelizumab) on MS-related cellular abnormalities using propensity score matching. Physiological gender differences are less pronounced in the CSF compared to blood, and age-related changes suggest decreased immunosurveillance of CNS by activated HLA-DR+T cells associated with natural aging. Results from patient samples support the concept of MS being immunologically single disease evolving in time. Initially, peripherally activated innate and adaptive immune cells migrate into CSF to form MS lesions. With progression, T cells (CD8+ > CD4+), NK cells, and myeloid dendritic cells are depleted from blood as they continue to accumulate, together with B cells, in the CSF and migrate to CNS tissue, forming compartmentalized inflammation. All MS drugs inhibit non-physiological accumulation of immune cells in the CSF. Although low-efficacy drugs tend to normalize it, high-efficacy drugs overshoot some aspects of CSF physiology, suggesting impairment of CNS immunosurveillance. Comparable inhibition of MS-related CSF abnormalities advocates changes within CNS parenchyma responsible for differences in drug efficacy on MS disability progression. Video summarizing all results may become useful educational tool.

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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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