Impact factors leading to renal impairment after liver transplantation: a single center consecutive 12 years’ experience
Batsaikhan Batsuuri1,2,3, Shiirevnyamba Avirmed1,2, Chuluunbileg Batbold4, Fidel Lopez-Verdugo5, Jade Nunez5, Ariunaa Togtokh6, Sergelen Orgoi2,3.
1Graduate School, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia; 2Department of Surgery, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia; 3The Transplantation Center, The First Central Hospital of Mongolia, Ulaanbaatar, Mongolia; 4Internal Medicine Residency, Health Developement Center, Ulaanbaatar, Mongolia; 5School of Medicine, University of Utah, Utah, United States; 6Department of Nephrology, Mongolian National University of Medical Science, Ulaanbaatar, Mongolia
Introduction: Renal impairment (RI) is a common life-threatening complication of cirrhosis, affecting one in every five patients. Although LT is a lifeline for cirrhotic patients with impaired renal function, postoperative acute RI is not uncommon and is influenced by multiple factors, leading to poor outcomes.
Hepatitis B virus (HBV) infection has been associated with increased risk of developing chronic kidney disease in some studies. The potential role of HBV infection in post-LT RI is unknown. This is likely due to the low prevalence of HBV infection amongst liver transplant recipients, which has been reported to be around 5% in the USA.
Low- and Middle income country like Mongolia has the highest rate of hepatocellular carcinoma and hepatitis B in the world. Mongolian First liver transplant (LT) performed at First Central Hospital of Mongolia (FCHM) in September 2011 in a collaborative effort with South Korea’s Asan Medical Center. In this context, the aim of our study is identify the role of HBV infection on the incidence of renal impairment after liver transplantation. We hypothesize that patients with HBV infection will have a higher rate of RI post-LT.
Methods: To determine the changes of renal function of peri- and post-LT as well as to identify risk factors for RI, we analyzed the First Central Hospital of Mongolia (FCHM) Liver Transplantation Database retrospectively, which includes patients who received LT between September 21, 2011, and December 31, 2022. Early RI was identified by measuring glomerular filtration rates by Cockcroft-Gault creatinine clearance formulation at pretransplantation, intraoperatively, 24h, 72h, 7d, 14d and 28d post LT.
Results: The results revealed that female gender (OR=3.06; 95% CI=1.58–5.91), Child-Tucotte-Pugh (CTP) score B and C (OR=4.23; 95% CI=0.92–19.41), (OR=7.68; 95% CI=1.67–35.30), preoperative continuous renal replacement therapy (CRRT) (OR=5.86; 95% CI=1.1–31.21), high graft to recipient weight ratio (GRWR) (OR=3.45; 95% CI=1.23–9.63) increased the risk of RI among recipients. Moreover, recipients’ age (OR=1.07; 95% CI=1.03–1.11), Model for End-Stage Liver Disease (MELD) score (OR=1.09; 95% CI=1.03–1.16), intraoperative leukoreduced red blood cells (LR-RBC) (OR=1.09; 95% CI=1.04–1.14), platelet (PLT) (OR=1.06; 95% CI=1.00–1.12+), fresh frozen plasma (FFP) (OR=1.07; 95% CI=1.02–1.11) and postoperative LR-RBC (OR=1.09; 95% CI=1.04–1.14), cryoprecipitate transfusion (OR=1.1; 95% CI=1.01–1.19), intubated hours (OR=1.04; 95% CI=1.01–1.07) increased slightly the risk of RI.
Conclusions: Female gender, high Child Pugh score, preoperative CRRT and high graft to recipient weight ratio are the primary risk factors RI after liver transplant surgery in Mongolia.
The liver transplantation team at the FCHM expresses our gratitude to Prof. Sung-Gyu Lee and Liver transplantation team from the Asan Medical Center, Seoul, South Korea. Their contribution was invaluable in the form of guidance and precious knowledge transfer for developing the robust liver transplantation program in Mongolia..
[1] Liver transplantation, kidney, renal impairment, survival
