Fluctuations of Estimated Glomerular Filtration Rate Outside Kidney Disease Improving Global Outcomes Diagnostic Criteria for Acute Kidney Injury in End-Stage Liver Disease Outpatients and Outcome Postliver Transplantation

Federica Fiacco, MD; Fabio Melandro, MD; Ilaria Umbro, MD; Assunta Zavatto, MD; Andrea Cappoli, MD; Edoardo Poli, MD; Stefano Ginanni Corradini, MD; Manuela Merli, MD; Francesca Tinti, MD; Italo Nofroni, PhD; Pasquale B. Berloco, MD; Massimo Rossi, MD; Anna Paola Mitterhofer, MD, PhD

doi:10.1097/TXD.0000000000000733

Transplantation Direct (Jan 2018)

Fluctuations of Estimated Glomerular Filtration Rate Outside Kidney Disease Improving Global Outcomes Diagnostic Criteria for Acute Kidney Injury in End-Stage Liver Disease Outpatients and Outcome Postliver Transplantation

Federica Fiacco, MD,
Fabio Melandro, MD,
Ilaria Umbro, MD,
Assunta Zavatto, MD,
Andrea Cappoli, MD,
Edoardo Poli, MD,
Stefano Ginanni Corradini, MD,
Manuela Merli, MD,
Francesca Tinti, MD,
Italo Nofroni, PhD,
Pasquale B. Berloco, MD,
Massimo Rossi, MD,
Anna Paola Mitterhofer, MD, PhD

Affiliations

Federica Fiacco, MD: 1 Nephrology Unit, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy.
Fabio Melandro, MD: 2 Organ Transplant Unit, Department of General Surgery, Sapienza University of Rome, Rome, Italy.
Ilaria Umbro, MD: 3 Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, Rome, Italy.
Assunta Zavatto, MD: 1 Nephrology Unit, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy.
Andrea Cappoli, MD: 1 Nephrology Unit, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy.
Edoardo Poli, MD: 4 Gastroenterology Unit, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy.
Stefano Ginanni Corradini, MD: 4 Gastroenterology Unit, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy.
Manuela Merli, MD: 4 Gastroenterology Unit, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy.
Francesca Tinti, MD: 3 Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, Rome, Italy.
Italo Nofroni, PhD: 5 Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
Pasquale B. Berloco, MD: 2 Organ Transplant Unit, Department of General Surgery, Sapienza University of Rome, Rome, Italy.
Massimo Rossi, MD: 2 Organ Transplant Unit, Department of General Surgery, Sapienza University of Rome, Rome, Italy.
Anna Paola Mitterhofer, MD, PhD: 1 Nephrology Unit, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy.

DOI: https://doi.org/10.1097/TXD.0000000000000733
Journal volume & issue: Vol. 4, no. 1
p. e222

Abstract

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Background. Renal dysfunction in end-stage liver disease (ESLD) results from systemic conditions that affect both liver and kidney with activation of vasoconstrictor systems. In this setting, estimated glomerular filtration rate (eGFR) may undergo variations often outside Kidney Disease Improving Global Outcomes criteria for acute kidney injury (AKI) diagnosis, whose meaning is not clear. The aim of this study was to evaluate eGFR variations in ESLD outpatients listed for liver transplant (liver Tx) and the association with post-Tx outcome. Methods. Fifty-one patients with ESLD were retrospectively evaluated from listing to transplant (L-Tx time), intraoperatively (Tx time), and up to 5 years post-Tx time. Variations between the highest and the lowest eGFR occurring in more than 48 hours, not satisfying Kidney Disease Improving Global Outcomes guideline, were considered as fluctuations (eGFR-F). Fluctuations of eGFR greater than 50% were defined as eGFR drops (DeGFR). Early graft dysfunction, AKI within 7 days, chronic kidney disease, and short- and long-term patient survivals were considered as outcomes. Results. All patients presented eGFR-F, whereas DeGFR were observed in 18 (35.3%) of 51 (DeGFR+ group). These patients presented higher levels of Model for End-stage Liver Disease score, pre-Tx bilirubin and significantly greater incidence of post-Tx AKI stages 2 to 3 compared with patients without drops (DeGFR−). DeGFR was the only independent predictive factor of the occurrence of post-Tx AKI. The occurrence of AKI post-Tx was associated with the development of chronic kidney disease at 3 months and 5 years post-Tx. Conclusions. Drops of eGFR are more frequently observed in patients with a worse degree of ESLD and are associated with a worse post-Tx kidney outcome.

Published in Transplantation Direct

ISSN: 2373-8731 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://journals.lww.com/transplantationdirect/Pages/default.aspx

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