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28 January 2020 : Original article  

Acute Kidney Injury and Renal Regional Oxygen Saturation During Pediatric Liver Transplantation

Barbara Sinner1ABCDEF*, Miriam Banas2CDEF, Clara Brunete-Lorenzo1BCDEF, Robert Zant3BCDE, Birgit Knoppke4DE, Marcus N. Scherer5DE, Bernhard M. Graf1ADE, Dirk Lunz1CDEF

DOI: 10.12659/AOT.919717

Ann Transplant 2020; 25:e919717

Abstract

BACKGROUND: Kidney injury is a complication among children undergoing liver transplantation (pLTx). Cystatin C serum concentration seems to be superior to creatinine-based determination of kidney injury in adults and children. Near-infrared spectroscopy (NIRS) technology provides non-invasive and real-time measurement of renal tissue oxygenation. Here, we compared renal tissue oximetry (rSrO₂) with conventional diagnostic criteria cystatin C and creatinine concentration in children undergoing pLTx.

MATERIAL AND METHODS: rSrO₂ was measured intraoperatively in children undergoing pLTx over the left kidney, and was statistically compared with pre- and postoperative serum creatinine and cystatin C concentrations.

RESULTS: rSrO₂ was affected by hemoglobin concentration, bilirubin concentration, and FiO₂. Statistical analysis demonstrated that rSrO₂ was significantly reduced in children with preoperative pathologic increased cystatin C concentrations compared to children without (63.7±4.3 vs. 53.4±4.9, p<0.05). We did not detect a significant difference in rSrO₂ between children who developed postoperative renal impairment, either determined by increased postoperative cystatin C concentration, creatinine concentration, or the pRIFLE criteria. Intraoperative increase or decrease in rSrO₂ did not predict the development of postoperative kidney injury.

CONCLUSIONS: In children with liver failure undergoing pLTx, a preoperative decrease in rSrO₂ indicates compromised renal function. However, intraoperative rSrO₂ is not predictive of postoperative kidney injury.

Keywords: Acute Kidney Injury, Liver Transplantation, Pediatrics, Spectroscopy, Near-Infrared, Child, Child, Preschool, Creatinine, cystatin C, Infant, Kidney, Oximetry, Oxygen

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358