The Association Between Vena Cava Implantation Technique and Acute Kidney Injury After Liver Transplantation
| Autor: | Michael P. Bokoch, Anna Mello, Dieter Adelmann, Claus U. Niemann, Vivienne Hannon, John Feiner, Kathleen D. Liu, Li Zhang, Rachel Hill, Rishi Kothari, Garrett R. Roll |
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| Rok vydání: | 2020 |
| Předmět: |
Transplantation
medicine.medical_specialty Warm Ischemia Time business.industry Incidence (epidemiology) medicine.medical_treatment Urology Acute kidney injury Renal function Retrospective cohort study Odds ratio 030230 surgery Liver transplantation urologic and male genital diseases medicine.disease 03 medical and health sciences 0302 clinical medicine medicine 030211 gastroenterology & hepatology cardiovascular diseases business Dialysis |
| Zdroj: | Transplantation. 104:e308-e316 |
| ISSN: | 0041-1337 |
| DOI: | 10.1097/tp.0000000000003331 |
| Popis: | BACKGROUND Acute kidney injury (AKI) after liver transplantation is associated with increased morbidity and mortality. It remains controversial whether the choice of vena cava reconstruction technique impacts AKI. METHODS This is a single-center retrospective cohort of 897 liver transplants performed between June 2009 and September 2018 using either the vena cava preserving piggyback technique or caval replacement technique without veno-venous bypass or shunts. The association between vena cava reconstruction technique and stage of postoperative AKI was assessed using multivariable ordinal logistic regression. Causal mediation analysis was used to evaluate warm ischemia time as a potential mediator of this association. RESULTS The incidence of AKI (AKI stage ≥2) within 48 h after transplant was lower in the piggyback group (40.3%) compared to the caval replacement group (51.8%, P < 0.001). Piggyback technique was associated with a reduced risk of developing a higher stage of postoperative AKI (odds ratio, 0.49; 95% confidence interval, 0.37-0.65, P < 0.001). Warm ischemia time was shorter in the piggyback group and identified as potential mediator of this effect. There was no difference in renal function (estimated glomerular filtration rate and the number of patients alive without dialysis) 1 y after transplant. CONCLUSIONS Piggyback technique, compared with caval replacement, was associated with a reduced incidence of AKI after liver transplantation. There was no difference in long-term renal outcomes between the 2 groups. |
| Databáze: | OpenAIRE |
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