Renal Impairment Is Associated with Reduced Outcome After Associating Liver Partition and Portal Vein Ligation for Stage
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ORIGINAL ARTICLE
Renal Impairment Is Associated with Reduced Outcome After Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy Tim Reese 1,2 & Mohammad H. Fard-Aghaie 1,2 & Georgios Makridis 1,2 & Alexandros Kantas 1,2 & Kim C. Wagner 1,2 & Massimo Malagó 3 & Richardo Robles-Campos 4 & Roberto Hernandez-Alejandro 5 & Eduardo de Santibañes 6 & Pierre-Alain Clavien 7 & Henrik Petrowsky 7 & Michael Linecker 7 & Karl J. Oldhafer 1,2 Received: 6 August 2019 / Accepted: 16 September 2019 # 2019 The Society for Surgery of the Alimentary Tract
Abstract Background Impaired postoperative renal function is associated with increased morbidity and mortality after liver resection. The role of impaired renal function in the two-stage hepatectomy setting of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is unknown. Methods An international multicenter cohort of ALPPS patients captured in the ALPPS Registry was analyzed. Particular attention was drawn to the renal function in the interstage interval to determine outcome after stage 2 surgery. Interstage renal impairment (RI) was defined as an increase of serum creatinine of ≥ 0.3 mg/dl referring to a preoperative value or an increase of serum creatinine of ≥ 1.5× of the preoperative value on the fifth postoperative day after stage 1. Results A total of 705 patients were identified of which 7.5% had an interstage RI. Patients developing an interstage RI were significantly older. During stage 1, a longer operation time, higher rate of intraoperative transfusions, and additional procedures were observed in patients that developed interstage RI. After stage 1, interstage RI patients had more major complications and higher interstage mortality (1% vs. 8%, p < 0.001). Furthermore, these patients developed more and severe complications after completion of stage 2. Mortality of patients with interstage RI was 38% vs. 8% without interstage RI. In 41% of patients with interstage RI, the renal function recovered before stage 2; however, the mortality after stage 2 remained 28% in those patients. Risk factors for the development of an interstage RI were age over 67 years, prolonged operative time, and additional procedure during stage 1. Conclusion This study shows that interstage RI is a predictor for interstage and post-stage 2 morbidity and perioperative mortality. The causality of impaired renal function on outcome, however, remains unknown. Interstage RI may directly cause adverse outcome but may also be a surrogate marker for major complications. Keywords Liver surgery . ALPPS . Kidney function . Acute kidney injury
* Karl J. Oldhafer [email protected] 1
Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Asklepios Hospital Barmbek, Rübenkamp 220, 22291 Hamburg, Germany
2
Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany
3
Department of HPB and Liver Transplant Surgery, Royal Free Hospital, University College London, London, UK
4
Virgen de la Arrixaca University
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