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Acute Kidney Injury After Liver Transplant Associated With Reduced Patient, Graft Survival HOBOKEN, NJ -- May 4, 2009 -- Even mild cases of acute kidney injury after liver transplantation are associated with lower survival for both the patient and the graft. With more severe injury, outcomes are even worse, according to a study published in the May issue of the journal Liver Transplantation. Acute kidney injury often occurs after liver transplantation because of blood loss or surgery-related events. Previous studies have estimated the incidence rate at 17% to 95% -- a wide range that reveals the lack of clear diagnostic criteria. To address this problem, Yousri Barri, MD, Baylor University Medical Center, Dallas, Texas, and colleagues sought to find the optimal definition for acute kidney injury after liver transplantation, and determine its impact on patients' long-term outcomes. They retrospectively studied patients who underwent liver transplantation at Baylor between 1997 and 2005 and applied 3 commonly used definitions of acute kidney injury, each based on change in serum creatinine from baseline. Definition were (1) a rise in serum creatinine of more than .5 mg/dL; (2) a rise of more than 1.0 mg/dL; (3) and a rise of more than 50% to above 2 mg/dL. The outcomes for each group of patients were compared with those from a control group that did not have kidney injury. The majority of liver transplant recipients experienced some degree of acute kidney injury. About 78% of the transplant recipients had a rise in creatinine or more than 0.5 mg/dL from baseline, considered mild in severity. About 46% had a moderate creatinine increase of 1.0 mg/dL or more, while 14% had a marked creatinine increase of 50% or more to above 2.0 mg/dL. "Even mild acute kidney injury defined as rise in serum creatinine of >0.5 mg/dL was associated with reduced patient and graft survival," the authors wrote. They suggested that this sensitive definition, which captures a large majority of liver transplant recipients, deserves attention and strategies for prevention. However, the strictest definition of acute kidney injury was associated with the worst outcomes, including higher incidence of cardiovascular events and end-stage renal disease. "This study shows that acute kidney injury, appropriately defined, has an important impact on long-term renal function and patient and graft survival post-liver transplantation," the authors concluded. "Whether acute kidney injury is the direct cause or simply associated with poor outcome will need further study." SOURCE: Wiley-Blackwell E-mail this page to a friend or colleague! To print, use this version