PROSPECTIVE COHORT STUDY OF THE RENAL OUTCOME IN OLT PATIENTS- A PRELIMINARY OBSERVATIONAL STUDY
Journal Title: Journal of Evidence Based Medicine and Healthcare - Year 2017, Vol 4, Issue 48
Abstract
BACKGROUND Postoperative Acute Renal Injury (ARI) is a serious clinical problem in Orthotopic Liver Transplantation (OLT). There are currently no standard criteria for the evaluation of patients with AKI or Chronic Kidney Disease (CKD) requiring Liver Transplantation (LT). The present study is taken up to fill up the lacunae. What is the use of MELD in predicting the outcome of OLT and renal function?. The aim of our study is to determine the association of various pretransplant risk factors, especially creatinine including the MELD score on patient renal function after OLT. MATERIALS AND METHODS A prospective, observational study of 35 consecutive liver transplantation patients including all patients who have been worked up for OLT and who underwent liver transplantation have been included. Patients who are previously diagnosed with CKD have been excluded. Preoperative AKI is defined as S. creatinine >1.2 mg/dL, postoperative AKI is defined as a persistent rise of 50% increase or more of the S. creatinine (S. Cr). RESULTS Total number of patients in the present study were (n=35), mean creatinine before liver transplantation was 1.0 ± 0.6 mg/dL. Serum creatinine 1 month, 3rd month and 6th month post transplantation was 0.8 ± 0.4 mg/dL, 0.9 ± 0.4 mg/dL and 1.03 ± 0.5 mg/dL, respectively. Males in the study were 34 (97.1%), total number of females were 1 (2.9%). Cadaver transplantation was done in 21 patients (60%). Living donor transplantation was done in 14 patients (40%). Median MELD score was 25. There was no significant change in the serum creatinine range at follow up in patients who had preop creatinine of 1. Those with creatinine of >1.2 mg/dL and labelled as having HRS were found to have follow up creatinine varying between 1.3-4.5 mg/dL. The overall post-LT patient survival was 88% at 1 year, total of 4.1% underwent CVVHDF and 2 patients died in the group. Remaining 2 patients are not dialysis dependent. CONCLUSION In this preliminary observation, there is a progressive rise in creatinine among patients who had a baseline creatinine of around 1 mg/dL and a higher MELD score in the pretransplant situation. Even without TAC toxicity, sepsis or underlying comorbidities. The group with low MELD and low creatinine seems to be related to better health on one side, but the other group with high creatinine and higher MELD have abnormal values are possibly related to preoperative conditions, also the donor and also the duration of the transplant surgery.
Authors and Affiliations
Arun Kumar Narayanan, Satish Balan, Sandeep Patil, Venugopal Bhaskaran Pillai, Shabeerali Thadakkun Usman
Keywords
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- EP ID EP220063
- DOI 10.18410/jebmh/2017/581
- Views 97
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