Acute renal failure (ARF) occurs in up to 50% of patients who undergo orthotopic liver transplantation (OLT). The aim of this study was to determine the incidence and predictors of ARF, and the rate of ARF-related mortality in OLT recipients in our center. The records of 84 patients who underwent OLT during a 16-year period were retrospectively analyzed. The mortality rate and incidence of ARF (defined as need for dialysis) were calculated, and predictive factors for ARF were identified. Of the 27 patients (32.1%) who developed ARF, 8 (29.6%) recovered renal function and were taken off dialysis, 17 (63%) died during long-term follow-up, and 2 (7.4%) developed end-stage renal disease. In the patients with ARF who were still alive at the time of the study, there was a 20% incidence of end-stage renal disease. Analysis showed that sex, age, diabetes mellitus, hypertension, preoperative serum albumin levels, and administration of tacrolimus, cyclosporine, vancomycin, amikacin or radiographic contrast agents were not associated with development of ARF (p>0.05 for all). Duration of operation and preoperative serum creatinine levels were correlated with development of ARF (p=0.02 and p=0.002, respectively). The mortality rate in the cases with ARF was significantly higher than the rate in the patients who did not develop ARF (70.2% vs. 47.4%, respectively; p=0.04).
The results indicate that longer operation time and elevated preoperative serum creatinine levels are predictors for the development of ARF in patients who have undergone OLT. Mortality rate was higher in the subgroup of OLT patients who developed ARF.