A study of complications in recipients with early kidney dysfunction after liver transplantation

Abstract

Background: Liver transplantation (LT) recipients frequently develop complication kidney dysfunction (KD), but the predisposing factors and long-term consequences of KD are not well understood. Post-LT complications that lead to graft failure and patient morbidity/mortality can be generally categorized as vascular, biliary, parenchymal and malignant. Main reasons for our study are to identify complications’ rate for early post-transplant KD and to evaluate the post-LT patients and graft survival rate. Aim: Our aim was to evaluate complications in recipients with early post-transplant KD and to investigate the survival rate after LT. Material and Methods: This study retrospectively and prospectively analyzed the demographic characteristics, preoperative and perioperative clinical parameters, as well as postoperative outcomes of patients who underwent liver transplantation (LT) at the First Central Hospital of Mongolia (FCHM) between September 2011 and December 2024. Renal function was evaluated by estimating the glomerular filtration rate (GFR) using the Cockcroft-Gault creatinine clearance formula at baseline (pre-transplantation) and at 24 hours, 72 hours, 7 days, 14 days, and 28 days following LT. Early and late complications following LT were classified according to the international classification. Ethical approval for the study was obtained at a meeting of the Research Ethics Review Board of the Mongolian National University of Medical Sciences (MNUMS). Results: In our study KD rate was 29.7%. Several factors increased the risk of KD among recipients. Post-LT complications’ related risk factors for KD was high MELD score (OR, 1.11; 95%CI, 1.06-1.16), Child-Turcotte-Pugh scores of B and C (OR, 5.57; 95%CI, 1.27-24.52 and OR, 8.21; 95%CI, 1.87–36.54), comorbidities (OR, 1.92; 95%CI, 1.14-3.23), post-LT acute bleeding (OR, 3.22; 95%CI, 1.22-8.46), early relaparotomy for revision (OR, 3.12; 95%CI, 1.34-7.28 respectively. Additionally, the survival rates for recipients with post-LT KD were 90.7% at 1 year and 81.3% at 3 years. Conclusions: 1. Variables like a recipient high age (p<0.001), female gender (p<0.001), elevated liver function scores (p<0.002), comorbidities (p=0.013), severe ascites (p=0.001), preop intensive care (p=0.026) are pre-LT risk factors for postLT KD. 2. Acute bleeding (p=0.013), early revision (p=0.006) are risk factors for post-LT KD. 3. Early KD in recipients who underwent LT affects both patient survival (Log Rank p=0.522; HR 1.3) and graft survival (Log Rank p=0.457; HR 1.26).