1
|
Lim C, Audureau E, Salloum C, Levesque E, Lahat E, Merle JC, Compagnon P, Dhonneur G, Feray C, Azoulay D. Acute kidney injury following hepatectomy for hepatocellular carcinoma: incidence, risk factors and prognostic value. HPB (Oxford) 2016; 18:540-8. [PMID: 27317959 PMCID: PMC4913133 DOI: 10.1016/j.hpb.2016.04.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 03/19/2016] [Accepted: 04/10/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) following hepatectomy remains understudied in terms of diagnosis, severity, recovery and prognostic value. The aim of this study was to assess the risk factors and prognostic value of AKI on short- and long-term outcomes following hepatectomy for hepatocellular carcinoma (HCC). METHOD This is a retrospective analysis of a single-center cohort of 457 consecutive patients who underwent hepatectomy for HCC. The KDIGO criteria were used for AKI diagnosis. The incidence, risk factors, and prognostic value of AKI were investigated. RESULTS AKI occurred in 67 patients (15%). The mortality and major morbidity rates were significantly higher in patients with AKI (37% and 69%) than in those without (6% and 22%; p < 0.001). Renal recovery was complete in 35 (52%), partial in 25 (37%), and absent in 7 (11%) patients. Advanced age, an increased MELD score, major hepatectomy and prolonged duration of operation were identified as independent predictors of AKI. AKI was identified as the strongest independent predictor of postoperative mortality but did not impact survival. CONCLUSION AKI is a common complication after hepatectomy for HCC. Although its development is associated with poor short-term outcomes, it does not appear to be predictive of impaired long-term survival.
Collapse
Key Words
- aki, acute kidney injury
- kdigo, kidney disease improving global outcomes
- hcc, hepatocellular carcinoma
- scr, serum creatinine
- rrt, renal replacement therapy
- cki, chronic kidney injury
- egfr, estimated glomerula filtration rate
- icu, intensive care unit
- auroc, area under the receiver operating curve
- os, overall survival
- meld, model for end stage liver disease
- or, odds ratio
- ci, confidence interval
Collapse
Affiliation(s)
- Chetana Lim
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France,INSERM, U965, Paris, France
| | - Etienne Audureau
- Department of Public Health, Henri Mondor Hospital, Créteil, France
| | - Chady Salloum
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France
| | - Eric Levesque
- Department of Anesthesia and Liver Intensive Care Unit, Henri Mondor Hospital, Créteil, France,INSERM, U955, Créteil, France
| | - Eylon Lahat
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France
| | - Jean Claude Merle
- Department of Anesthesia and Liver Intensive Care Unit, Henri Mondor Hospital, Créteil, France
| | - Philippe Compagnon
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France,INSERM, U955, Créteil, France
| | - Gilles Dhonneur
- Department of Anesthesia and Liver Intensive Care Unit, Henri Mondor Hospital, Créteil, France
| | - Cyrille Feray
- INSERM, U955, Créteil, France,Department of Hepatology, Henri Mondor Hospital, Créteil, France
| | - Daniel Azoulay
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France,INSERM, U955, Créteil, France,Correspondence: Daniel Azoulay, Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor hospital, 51 avenue de Lattre de Tassigny, 94010 Créteil, France. Tel: + 33 1 49 81 25 48. Fax. + 33 1 49 81 24 32.Department of Hepatobiliary and Pancreatic Surgery and Liver TransplantationHenri Mondor hospital51 avenue de Lattre de TassignyCréteil94010France
| |
Collapse
|