RISK-FACTORS FOR ACUTE-RENAL-FAILURE REQUIRING DIALYSIS AFTER LIVER-TRANSPLANTATION

Acute renal failure (ARF) is a common and severe complication after li ver transplantation (LT). The aim of this study was to ascertain the i mpact of ARF requiring dialysis in the outcome of LT and to analyze th e risk factors leading to this event in the early postoperative period . From October 1988 to December 1994, 172 LT were performed in 158 pat ients. Postoperative ARF occurred in 88 transplants (51.1%) during the early postoperative period: mild ARF was found in 46 (serum creatinin e 1.5-3 mg/dl), moderate ARF in 12 (serum creatinine > 3 mg/dl) and se vere ARF in 30 (serum creatinine > 3 mg/dl with dialysis requirement). Preoperative, intraoperative, and postoperative variables were studie d, comparing patients presenting severe ARF with the remaining patient s. Postoperative mortality in the dialysed group was much higher than in the non-dialysis group (50% vs. 13.4%) (p < 0.001) and 1-yr actuari al graft survival was 73.4% for the non-dialysed group compared with 4 0.9% for the dialysed group (p < 0.05). Among 38 variables investigate d, only two factors had independent prognostic value in multivariate a nalysis: preoperative serum creatinine > 1.5 mg/dl (OR = 4.4, p = 0.00 6) and graft dysfunction grades III-TV (OR = 8.9, p = 0.001). In concl usion, ARF is a severe complication post-LT; its appearance could be p redicted in patients with pre-transplant renal dysfunction, severe gra ft dysfunction, or both. However, in many cases renal function may rev ert to normal if treated aggressively with early dialysis support.