Dados do Trabalho

Título

FLUID BALANCE AND OLIGURIA IN EARLY ACUTE KIDNEY INJURY DIAGNOSIS AFTER LIVER TRANSPLANT

Introdução

Acute Kidney Injury (AKI) is a frequent complication of liver transplant (LT), associated with increased morbidity and mortality. Early diagnosis can translate into secondary preventive measures and improve outcomes.
We hypothesized that adjusting Serum creatinine (Scr) for positive fluid balance (FB) and applying urine output (UO) criterion would improve timing of AKI diagnosis. In addition, we investigate if sequential assessment of urinary biochemistry after LT can improve prediction of early post-operative AKI development.

Material e Método

In a prospective cohort study, from June 13 to October 14, we enrolled 55 patients > 18 years undergoing liver transplant.
We recorded UO, FB and standard of care labs from the pre-operative period until hospital discharge.
Urine and blood samples for biomarker assessment were collected preoperatively before induction of anesthesia, after portal reperfusion, and 6, 18, and 24 hours after surgery.
AKI diagnosis was based on UO and the sCr KDIGO criteria before and after correcting sCr for FB (sCr adjusted), using the formula: ((weight*0,6)+(FB)/(weight*0,6).
Early AKI was considered if diagnosis within 48 hs after LT.

Resultados

Twenty-seven percent (15) of patients developed AKI based on Scr criterion.
Thirty-eight percent (21) of patients developed AKI by adjusting Scr for FB.
Seventy-eight percent (43) of patients developed AKI applying the UO criterion.
Patients developing early AKI had a higher decline and maintained lower of FE Urea levels for 24h.
FeU values were significantly different 6 h after surgery in early AKI patients.
Patients with early AKI based on both criteria or exclusively by UO had higher mortality and longer ICU and hospital stay than non-AKI patients.

Discussão e Conclusões

Applying UO criteria and adjusting Scr for FB can help in the early identification of patients developing AKI after liver transplant.
Tubular function assessment could be utilized along with biomarkers of kidney injury to identify patients with increased risk of developing AKI.
Standardized approach for early AKI diagnosis in high-risk patients could improve outcomes.

Palavras Chave

acute kidney injury, liver transplant, biomarkers