JCM, Vol. 14, Pages 5452: Incidence and Predictive Factors of Acute Kidney Injury After Major Hepatectomy: Implications for Patient Management in Era of Enhanced Recovery After Surgery (ERAS) Protocols
Journal of Clinical Medicine doi: 10.3390/jcm14155452
Authors:
Henri Mingaud
Jean Manuel de Guibert
Jonathan Garnier
Laurent Chow-Chine
Frederic Gonzalez
Magali Bisbal
Jurgita Alisauskaite
Antoine Sannini
Marc Léone
Marie Tezier
Maxime Tourret
Sylvie Cambon
Jacques Ewald
Camille Pouliquen
Lam Nguyen Duong
Florence Ettori
Olivier Turrini
Marion Faucher
Djamel Mokart
Background: Acute kidney injury (AKI) frequently occurs following major liver resection, adversely affecting both short- and long-term outcomes. This study aimed to determine the incidence of AKI post-hepatectomy and identify relevant pre- and intraoperative risk factors. Our secondary objectives were to develop a predictive score for postoperative AKI and assess the associations between AKI, chronic kidney disease (CKD), and 1-year mortality. Methods: This was a retrospective study in a cancer referral center in Marseille, France, from 2018 to 2022. Results: Among 169 patients, 55 (32.5%) experienced AKI. Multivariate analysis revealed several independent risk factors for postoperative AKI, including age, body mass index, the use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, time to liver resection, intraoperative shock, and bile duct reconstruction. Neoadjuvant chemotherapy was protective. The AKIMEBO score was developed, with a threshold of ≥15.6, demonstrating a sensitivity of 89.5%, specificity of 76.4%, positive predictive value of 61.8%, and negative predictive value of 94.4%. AKI was associated with increased postoperative morbidity and one-year mortality following major hepatectomy. Conclusion: AKI is a common complication post-hepatectomy. Factors such as time to liver resection and intraoperative shock management present potential clinical intervention points. The AKIMEBO score can provide a valuable tool for postoperative risk stratification.
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Henri Mingaud www.mdpi.com
