Hindawi Journal of Transplantation Volume 2018, Article ID 5910372, 9 pages https://doi.org/10.1155/2018/5910372
Research Article Renal Dysfunction after Living-Donor Liver Transplantation: Experience with 500 Cases Ehab E. Abdel-Khalek ,1 Alrefaey K. Alrefaey,2 Amr M. Yassen,2 Ahmed Monier,3 Hesham M. Elgouhari,4 Mohamed Samy Habl,1 Gehad Tawfik,5 Thuraya Elzayat,5 Reham Adly Zayed,1 and Mohamed Abdel-Wahab3 1
Liver Transplantation Unit and Department of Internal Medicine, Faculty of Medicine, University of Mansoura, Mansoura, Egypt Department of Anaesthesia and Surgical Intensive Care, Faculty of Medicine, University of Mansoura, Mansoura, Egypt 3 Liver Transplantation Unit and Gastroenterology Center, Faculty of Medicine, University of Mansoura, Mansoura, Egypt 4 Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, USA 5 House Officer, University of Mansoura, Mansoura, Egypt 2
Correspondence should be addressed to Ehab E. Abdel-Khalek;
[email protected] Received 24 August 2018; Accepted 28 November 2018; Published 23 December 2018 Academic Editor: Gian Luigi Adani Copyright © 2018 Ehab E. Abdel-Khalek et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. The possible risk factors for chronic kidney disease in transplant recipients have not been thoroughly investigated after living-donor liver transplantation. Material and Methods. A retrospective cohort study of consecutive adults who underwent living-donor liver transplantation between May 2004 and October 2016, in a single center, was conducted. Kidney function was investigated successively for all the patients throughout the study period, with 12 months being the shortest follow-up. Postoperative renal dysfunction was defined in accordance with the Chronic Kidney Disease Epidemiology Collaboration criteria. The patients’ demographic data, preoperative and intraoperative parameters, and outcomes were recorded. A calcineurin inhibitor-based immunosuppressive regimen, either tacrolimus or cyclosporine, was used in all the patients. Results. Of the 413 patients included in the study, 33 (8%) who survived for ≥1 year experienced chronic kidney disease 1 year after living-donor liver transplantation. Twenty-seven variables were studied to compare between the patients with normal kidney functions and those who developed chronic kidney disease 1 year after living-donor liver transplantation. Univariate regression analysis for predicting the likelihood of chronic kidney disease at 1 year revealed that the following 4 variables were significant: operative time, P < 0.0005; intraoperative blood loss, P < 0.0005; preoperative renal impairment, P = 0.001; and graft-to-recipient weight ratio (as a negative predictor), P < 0.0005. In the multivariate regression analysis, only 2 variables remained as independent predictors of chronic kidney disease at 1 year, namely, operative time with a cutoff value of ≥714 minutes and graft-to-recipient weight ratio as a negative predictor with a cutoff value of
