Search for New Nephroprotective Strategies in Orthotopic Liver Transplantation
National Center of Organ Transplantation, Minsk, Belarus
Kidney Unit, Oxford Transplant Center and Kidney Unit, Oxford, United Kingdom
Meeting: 2013 American Transplant Congress
Abstract number: D1701
The classical OLT technique (>90% of cases in our centre) leads to increased rates of acute kidney injury (AKI up to 81, 4%). The purpose of the study was to search for reliable nephroprotective strategies in the OLT.
Methods. The risk factors were analyzed retrospectively on the basis of the National Transplant Center Liver Transplantation Database including 97 liver transplants performed between 2008 to 2012. The OLT technique was classical in 89 (92%) cases. Nephroprotection techniques included blood coagulation monitoring (ROTEM) and volume restriction during OLT followed by delay of CNI administration in the early postoperative period after OLT. Delay of CNI after OLT (start from day 3-5) were evaluated in a group of 8 patients. Control group included 18 patients compatible in age, MELD score and eGRF before OLT.
Results. Local data suggests the strongest risk factors for severe AKI were preexisting CKD (OR=13,9, p value=0,002, 95% Cl=2,7-72,3), early LT dysfunction (OR=7,5, p value=0,005, 95% Cl= 1,8-31,7), blood loss >1500ml (OR=5,7, p value=0,01, 95% Cl=1,5-21,7)and CVP> 8 mmHg(OR=3,1, p value=0,0024, 95% Cl=1,3-7,4). Some can be modified during the OLT surgery and thereafter.
Results: Restrictive fluid management was implemented in 66 liver transplant recipients to achieve target CVP less than 8 mmHg. This showed some degree of benefit for patients with preexisting CKD and led to less AKI. The precise coagulation control with ROTEM (n=56) did not show any significant statistical benefit for preservation of renal function. Both methods in combination led to a statistically proven decrease in the rate of AKI in OLT.
| Variable | CVP<8mm Hg with ROTEM | CVP<8mm Hg without ROTEM | p value |
| eGFR, ml/min, D0 | 71(46-108) | 85(64-107) | 0,126* |
| CKD (y/n) | 17/23(42,5%) | 11/46(19,3%) | 0,022** |
| eGFR, ml/min, D 30 | 72(53-101) | 66(46-104) | 0,771* |
| AKI (y/n) | 28/12(70,0%) | 50/7(87,7%) | 0,039** |
| AKI with RRT (y/n) | 6/34(15%) | 11/46(19,3%) | 0,787** |
Delay of CNI after OLT led to better native kidneys function 3 month post-transplant. The eGFR was statistically better in “delayed” group (130±6, 0 ml/min vs 79, 5±8, 7 ml/min in control group, p=0,02).
Conclusion. Nephroprotection in OLT can be achieved by use of restrictive fluid management, precise coagulation control with ROTEM and by delay of CNI administration.
To cite this abstract in AMA style:
Minou A, Kalachyk A, Dzyadzko A, Scherba A, Rummo O, Harden P. Search for New Nephroprotective Strategies in Orthotopic Liver Transplantation [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/search-for-new-nephroprotective-strategies-in-orthotopic-liver-transplantation/. Accessed November 23, 2024.« Back to 2013 American Transplant Congress