Background. Renal impairement is one of the most common complications following liver transplantation (LT) and it is associated with an increased length of stay in the post-anesthesia care unit (PACU) and late hospital discharge, with a negative impact on the patient’s outcome. Objective. The aim of this study was to evaluate independent predictors and the natural history of renal dysfunction. Materials and methods. Forty-nine consecutive patients had undergone LT in a single transplant center, between January and June 2012, having a mean age of 46 years (range 14-69years) and a mean MELD score of 16 (range 10-30). We retrospectively evaluated the renal function in the early postoperative period (POP) and at 1, 3 and, respectively 6 months post LT. Results. Thirty-three percent of LT patients (n=16) developed AKI in the early POP with a median duration of 2.5 days (range 1-35). In 8.2% of patients (n=4) renal replacement therapy (RRT) was necessary. In multivariate analysis, we found that baseline serum creatinine (SCr) (p=0,038), pretransplant RRT (p=0,009), cardiovascular disease (p=0,002), cardiopulmonary resuscitation of the donor (p=0,05), the amount of blood loss (p=0,03), intraoperatory blood pressure (p=0,002) and the vassopresor dose (p=0,01) were significantly associated with AKI development. Development of renal dysfunction correlated with a prolonged stay in the PACU (95%CI=0.315-0.974, p=0.001). Cardiovascular pathology was associated with a greater incidence of chronic renal disease (CRD) at the 6th month follow-up (p=0,007). Both peak postoperatory SCr levels(p=0,028) and SCr levels at the end of first month (p=0,004) significantly corelateed with the development of CRD. In the multivariate analysis, peak posttransplant SCr levels(p=0,028), recipient’s age(p=0,003), intraoperatory blood pressure and vassopresor dose(p=0,017) were associated with CRD. Conclusions. We conclude that cardiovascular disease and intraoperatory cardiovascular instability represent risk factors for both AKI and CRD. Thus, preventive or therapeutic interventions like agressive intraoperatory haemodynamic management should be considered for high-risk patients. Further studies are necessary to evaluate risk factors for long term renal dysfunction and the need for chronic RRT.

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