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Does Choice of Inferior Vena Cava Reconstruction Technique Have an Impact on the Short and Long Term Postoperative Renal Function in Liver Transplant Recipient?

S. Chartier-Plante1, S. Asrani2, J. Bayer2, H. Fernandez2, A. Gupta2, E. Martinez2, G. J. Mckenna2, N. Onaca2, N. Onaca2, R. M. Ruiz2, G. Saracino2, A. Wall2, G. Testa2

1Vancouver General Hospital, Vancouver, BC, Canada, 2Baylor University Medical Center, Dallas, TX

Meeting: 2020 American Transplant Congress

Abstract number: 261

Keywords: Liver transplantation, Renal function

Session Information

Session Name: Kidney Issues in Liver Transplantation

Session Type: Oral Abstract Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:45pm

 Presentation Time: 4:03pm-4:15pm

Location: Virtual

*Purpose: Postoperative acute kidney injury (AKI) is common after liver transplant (Oltx). It is associated with increased morbidity and mortality and is a risk factor for chronic kidney disease (CKD) following Oltx. We evaluated the impact of type of caval (IVC) reconstruction on post-operative AKI and eGFR at 1-year post-transplant.

*Methods: Data on 566 patients who received a primary oltx at a single center between 2012 and 2017 were retrospectively collected from a prospective database. Patients were divided according to the method used to reconstruct the IVC; Piggyback (PB, n=219), caval interposition (CC, n=293) and patients who underwent CC with venovenous bypass (VVBP, n=54). Primary outcomes were AKI at 48h postoperatively using KDIGO classification and calculated glomerular filtration rate (eGFR) at 1-year post-transplant.

*Results: 413 patients developed AKI (72.7%) and 75 patients (13.2%) required renal replacement therapy post oltx. The proportion of patients meeting KDIGO AKI stage 1, 2 & 3 was similar among the 3 groups (table 1, p=0.095). However, at 1-year post oltx, patients in the CC group were more likely to have eGFR < 60 mL/min/1.73m2 (table 1, p=0.021). Interestingly, more patients at time of OLTX were hospitalized (ward or ICU) in the PB group ( 30.6%) and VVBP group (31.5%) compared to CC group (17.4%) (p=0.006) and patients in the PB group had a lower mean arterial pressure at time of anesthesia induction (p=0.043). In the PB group, more patients required hemodialysis (PB:18.7%, CC:9.22% VVBP:16.7%, p=0.006) and reexploration (PB:25.1% CC:14.0% VVBP:24.1%, p=0.004) post oltx.

*Conclusions: All 3 types of IVC reconstruction techniques have a similar incidence of postoperative AKI despite a selection bias toward PB in sicker patients. CC is associated with lower eGFR at 1-year post oltx.

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To cite this abstract in AMA style:

Chartier-Plante S, Asrani S, Bayer J, Fernandez H, Gupta A, Martinez E, Mckenna GJ, Onaca N, Onaca N, Ruiz RM, Saracino G, Wall A, Testa G. Does Choice of Inferior Vena Cava Reconstruction Technique Have an Impact on the Short and Long Term Postoperative Renal Function in Liver Transplant Recipient? [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/does-choice-of-inferior-vena-cava-reconstruction-technique-have-an-impact-on-the-short-and-long-term-postoperative-renal-function-in-liver-transplant-recipient/. Accessed May 11, 2025.

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