Introduction
Acute kidney injury (AKI) is a frequent and severe complication following liver transplantation (LT), significantly affecting postoperative outcomes. The role of nonselective beta-blockers (NSBBs) in patients with liver cirrhosis (LC) remains controversial. This study aims to investigate the association between preoperative NSBB use and AKI in living donor liver transplantation (LDLT) recipients.
Methods
We retrospectively evaluated 2,972 adult LDLT recipients from January 2012 to July 2022. Patients were divided into two groups based on preoperative NSBB use. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) analyses were conducted to assess the association between preoperative NSBB use and postoperative AKI. Multiple logistic regression analyses were also performed to identify risk factors for AKI.
Results
The overall incidence of AKI was 57.9% (1,721 cases). The NSBB group had a higher incidence of AKI compared to the non-NSBB group (62.4% vs. 56.7%; P = 0.011). However, after PSM and IPTW analyses, no significant difference in AKI incidence was found between the groups (PSM: OR 1.13, 95% CI 0.93−1.37, P = 0.230; IPTW: OR 1.20, 95% CI 0.99−1.44, P = 0.059). Multivariate logistic regression analysis also showed no significant association between preoperative NSBB use and AKI (OR 1.16, 95% CI 0.96−1.40, P = 0.118).
Discussion
Our findings indicate that preoperative NSBB use is not significantly associated with postoperative AKI in LDLT recipients. This aligns with previous studies suggesting that NSBBs do not adversely affect renal function in patients with LC. However, the study highlights the need for further research to validate these results, considering the complex interplay of factors influencing AKI in LT recipients.
Risk Factors for AKI
Multivariate analysis identified several factors associated with post-LT AKI, including body mass index (BMI), hepatitis C virus (HCV) infection, Model for End-Stage Liver Disease (MELD) score, intractable ascites, and anesthetic time. These findings are consistent with previous research on AKI risk factors in LT recipients.
Despite the higher incidence of AKI in the NSBB group, no significant differences were observed in 1-year graft failure, mortality, overall graft failure, or overall mortality between the NSBB and non-NSBB groups. This suggests that preoperative NSBB use does not significantly impact long-term outcomes in LDLT recipients.
Conclusion
Preoperative NSBB use is not significantly associated with postoperative AKI in LDLT recipients. These findings suggest that NSBB therapy can be safely continued in LT candidates without increasing the risk of AKI. Further multicenter, prospective studies are needed to confirm these results and explore the underlying mechanisms.
References
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Authors: Hye-Won Jeong, Jae Hwan Kim, Sang-bin Han, Hye-Mee Kwon, In-Gu Jun, Jun-Gol Song, Gyu-Sam Hwang