Fatores de risco para lesão renal aguda e mortalidade nos pacientes submetidos a transplante hepático

Abstract

Acute kidney injury is a significant cause of morbidity and mortality in patients undergoing liver transplantation. Objectives: To evaluate the incidence and risk factors for acute kidney injury (AKI), as well as assess the impact of acute kidney injury during hospitalization, the glomerular filtration rate 3 months after liver transplantation and impact on mortality in 30 days . Evaluation of the subgroup of patients who required hemodialysis and its risk factors and the impact on hospitalization. Methods: Retrospective cohort of patients undergoing liver transplantation at the University Hospital Walter Cantídio (HUWC), from January 2013 to January 2014.Resultados: Among 134 patients evaluated 67 (50%) were male. The median age and interquartile range were 56 (48-62). Of these patients, 64 (47%) had acute kidney injury after liver transplantation. Through logistic regression analysis it was observed that viral liver diseases, warm ischemia time and dosage of serum lactate were independent markers for development of AKI (OR 2.9 95% CI = 1.2 to 7 and, and OR 1.1 95% CI = 1.01 to 1.2, OR 1.3 95% CI = 1.02 to 1.89 and, respectively). The ICU and hospital stay was higher in patients with AKI, 4 (3-7) days vs 3 (2-4) days with p = 0.001 and 16 (9 -26) vs 10 (8-14) with p = 0.001 respectively . The glomerular filtration rate 3 months after surgery in the group with AKI did not possess statistical difference when compared to those without AKI. After logistic regression analysis, it was observed that the presence of AKI was an independent risk factor for mortality among patients undergoing liver transplantation (OR 4.3 CI 95% = 1.3 to 14.6). Of the 64 patients who had AKI 33 (51%) required hemodialysis. After logistic regression analysis, the MELD Na ≥ 22 (reference group <22) was a predictor for starting hemodialysis with 8.4 more likely the patient starting hemodialysis compared with the reference group (OR 8.4 CI 95% = 1, 5 to 46.5) .The patients undergoing hemodialysis had a long ICU stay and longer duration of mechanical ventilation when compared to the group that did not receive hemodialysis [6 (3.5 to 14)] vs [3 (2-4)] with p = 0.007; [3 (1.5 to 11)] vs [1 (1-2)] with p = 0.001 respectively. Conclusions: viral liver disease, prolonged warm ischemia and dosage of elevated serum lactate were independent predictors for development of AKI among patients undergoing liver transplantation at HUWC. Patients with AKI had a longer hospital and ICU stay. The presence of AKI was an independent marker for mortality among patients undergoing liver transplantation. The value of MELD In> = 22 was a predictor for starting dialysis in patients with AKI, these patients had a longer ICU stay and mechanical ventilation.