Role of thrombocytopenia in risk stratification for acute kidney injury after living donor liver transplantation

Abstract

The aim of our study was to investigate pre and intraoperative clinical factors, including platelet count, which could inform risk stratification of early acute kidney injury (AKI) after living donor liver transplantation (LDLT). Additionally, the impact of severe thrombocytopenia on AKI risk was assessed using a propensity score (PS)-matched analysis. In total, 591 adult patients who underwent LDLT between January 2009 and December 2018 at our hospital were retrospectively analyzed. Early postoperative AKI was determined based on the KDIGO criteria, and 149 patients (25.2%) developed AKI immediately after surgery. In a multivariate analysis, a lower preoperative platelet count was significantly associated with early postoperative AKI, together with diabetes mellitus, lower hourly urine output, and longer graft ischemic time; furthermore, a decrease in platelet count was correlated with AKI severity. After adjusting for the PS, the probability of AKI was significantly (1.9-fold) higher in patients with severe thrombocytopenia than in those without severe thrombocytopenia. Patients with thrombocytopenia showed a higher postoperative incidence of AKI and a higher requirement for dialysis than those without thrombocytopenia. The platelet count can easily be obtained via regular blood analysis of patients scheduled for LDLT and can be used to identify patients at risk for AKI.

Keywords:

• Acute kidney injury
• living donor liver transplantation
• platelets

Acknowledgements

All authors thank Eunju Choi and Hyeji An (Anesthesia Nursing Unit, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea) for participation of our study.

Author contributions

Jaesik Park contributed study concept, analysis and interpretation of data, and drafting of manuscript; Min Suk Chae contributed study concept and design, analysis and interpretation of data, drafting and critical revision of manuscript for important intellectual content; Jangsu Jeong, Ho Joong Choi, Jung-Woo Shim, Hyung Mook Lee, Sang Hyun Hong, Chul Soo Park, and Jong Ho Choi contributed to interpretation of data and critical revision of manuscript for important intellectual content. All authors have reviewed the manuscript and approved its final version.

Disclosure statement

No author has any conflict of interest regarding the publication of this article.

None of the authors have any conflict of interest to report in relation to this work.

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There are no grants and financial support to declare.

Supplementary material

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Additional information

Funding

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