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. 2022 May 30;11(11):3100.
doi: 10.3390/jcm11113100.

Excess Risk of Major Adverse Cardiovascular and Kidney Events after Acute Kidney Injury following Living Donor Liver Transplantation

Yi-Chia Chan  1 , Cheng-Hsi Yeh  1 , Lung-Chih Li  2 , Chao-Long Chen  1 , Chih-Chi Wang  1 , Chih-Chi Lin  1 , Aldwin D Ong  1 , Ting-Yu Chiou  2 , Chee-Chien Yong  1
Affiliations

Excess Risk of Major Adverse Cardiovascular and Kidney Events after Acute Kidney Injury following Living Donor Liver Transplantation

Yi-Chia Chan et al. J Clin Med. .

Abstract

Acute kidney injury (AKI) is a well-known risk factor for major adverse kidney events (MAKE) and major adverse cardiovascular events (MACE) in nontransplant settings. However, the association between AKI after liver transplantation (LT) and MACE/MAKE is not established. A retrospective cohort analysis including 512 LT recipients was conducted. The incidence of post-LT AKI was 35.0% (n = 179). In total, 13 patients (2.5%) developed de novo coronary artery disease (CAD), 3 patients (0.6%) diagnosed with heart failure (HF), and 11 patients (2.1%) had stroke. The post-LT AKI group showed a higher incidence of CAD and HF than the no post-LT AKI group (4.5% versus 1.5%, p = 0.042; 1.7% versus 0%, p = 0.018; respectively), while there was no significant difference in the stroke events (2.8% versus 1.8%, p = 0.461). Through Cox regression analysis, history of cardiovascular disease (HR 6.51, 95% CI 2.43-17.46), post-LT AKI (HR 3.06, 95% CI 1.39-6.75), and pre-LT diabetes (HR 2.37, 95% CI 1.09-5.17) were identified as independent predictors of MACE; pre-LT chronic kidney disease (HR 9.54, 95% CI 3.49-26.10), pre-LT diabetes (HR 3.51, 95% CI 1.25-9.86), and post-LT AKI (HR 6.76, 95% CI 2.19-20.91) were risk factors for end-stage renal disease. Post-LT AKI is predictive for the development of MACE and MAKE.

Keywords: acute kidney injury; cardiovascular disease; liver transplantation; major adverse cardiovascular events; major adverse kidney event.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Estimated probability of major adverse cardiovascular events after living donor liver transplantation using the Kaplan–Meier method.
Figure 2
Figure 2
Estimated probability of ESRD occurrence after living donor liver transplantation using the Kaplan–Meier method. (A) Curves by post-LT AKI status. (B) Curves by post-LT AKI and pre-LT CKD status.
Figure 3
Figure 3
All-cause mortality rate after living donor liver transplantation with increasing stages of postoperative acute kidney injury. KDIGO—Kidney Disease Improving Global Outcome. * These post-LT AKI patients needing dialysis therapy were also included in the group of AKI stage III.
See this image and copyright information in PMC

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