Addition of a Temporary Portocaval Shunt Does Not Reduce Acute Kidney Injury in Caval-Sparing Liver Transplantation

Abstract

Acute kidney injury (AKI) is a common complication following liver transplantation (LT), with multifactorial etiology. It is believed that perioperative hemodynamic instability could lead to AKI. A temporary portocaval shunt (TPCS) could possibly prevent this, but its beneficial effect is still controversial, especially in caval-sparing LT. Therefore, the aim of this study was to evaluate whether the use of a TPCS during hepatectomy reduces the incidence and severity of post-LT AKI in caval-sparing LT, defined according to AKIN criteria. Between January 2005 and August 2023, all orthotopic LTs performed in a single center were retrospectively analyzed and were divided into a TPCS group (n = 134) and a no-TPCS group (n = 260). Serum creatinine was collected right before LT and daily during the first week post-LT. In multivariate analysis, TPCS was not related to AKI, while diabetes mellitus (p = 0.01) and LabMELD (p = 0.02) were. When comparing TPCS and no-TPCS groups, no differences were seen in median increase of serum creatinine post-LT (TPCS; 12 µmol/L (-4–52) versus no-TPCS; 14 µmol/L ± (-3–52) (p = 0.94)), number of post-LT AKI (TPCS; 31% versus no-TPCS; 33% (p = 0.57)), or severity of post-LT AKI (p = 0.90). In conclusion, the application of a TPCS during hepatectomy is not associated with less post-LT AKI or less severe post-LT AKI when using a caval-sparing LT technique.