Acute kidney injury and post-reperfusion syndrome in liver transplantation

Ilaria Umbro, Tinti Francesca, Irene Scalera, Felicity Evison, Bridget Gunson, Adnan Sharif, James W. Ferguson, Paolo Muiesan, Anna Paola Mitterhofer

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In the past decades liver transplantation (LT) has become the treatment of choice for patients with end-stage liver disease (ESLD). The chronic shortage of cadaveric organs for transplantation led to the utilization of a greater number of marginal donors such as older donors or donors after circulatory death (DCD).
The improved survival of transplanted patients has increased the frequency of long-term complications, in particular chronic kidney disease (CKD). Acute kidney injury (AKI) post-LT has been recently recognized as an important risk factor for the occurrence of de novo CKD in the long-term outcome. The onset of AKI post- LT is multifactorial, with pre-LT risk factors involved, including higher Model for ESLD score, more severe ESLD and pre-existing renal dysfunction, either with intra-operative conditions, in particular ischaemia reperfusion injury responsible for post-reperfusion syndrome (PRS) that can influence recipient’s morbidity
and mortality. Post-reperfusion syndrome-induced AKI (PRS-induced AKI) is an important complication post-LT that characterizes kidney involvement caused
by PRS with mechanisms not clearly understood and implication on graft and patient survival. Since pre-LT risk factors may influence intra-operative events
responsible for PRS-induced AKI, we aim to consider all the relevant aspects involved in PRS-induced AKI in the setting of LT and to identify all studies that better clarified the specific mechanisms linking PRS and AKI. A PubMed search was conducted using the terms LT AND AKI; LT AND PRS; acute kidney injury AND PRS; acute kidney injury AND DCD AND LT. Five hundred seventy four articles were retrieved on PubMed search. Results were limited to title/abstract of English-language articles published between 2000 and 2015. Twenty three
studies were identified that specifically evaluated incidence, risk factors and outcome for patients developing PRS-induced AKI in LT. In order to identify
intra-operative risk factors/mechanisms specifically involved in PRS-induced AKI, avoiding confounding factors, we have limited our study to “acute kidney
injury AND DCD AND LT”. Accordingly, three out of five studies were selected for our purpose.
Original languageEnglish
JournalWorld Journal of Gastroenterology
Issue number40
Publication statusPublished - 28 Oct 2016

Bibliographical note

Article in press: 28 September 2016; Published online: 28 October 2016
Open access - Creative Commons Attribution Non Commercial (CC BY-NC 4.0) License


  • Liver transplantation
  • Acute kidney injury
  • Post-reperfusion syndrome
  • Donation after circulatory death
  • Chronic kidney disease


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