Acute Kidney Injury after ALPPS Procedure (Case Report)
https://doi.org/10.16931/1995-5464.20174109-115
Abstract
Acute kidney injury (AKI) is a serious complication after major liver resection. It may be caused by post-hepatectomy liver failure (PLF). ALPPS (Associating Liver Partition and Portal Vein Ligation for Staged hepatectomy) procedure is an effective way for PLF prevention in cases of small future remnant volume or bilobar liver lesions, but the risk of AKI following this procedure is unknown.
Herein we present and discuss the case of a 23-year-old man with hepatic alveococcosis who underwent ALPPS procedure. Despite absence of any risk factors AKI (RIFLE-F) followed by renal replacement therapy (RRT) has occurred within few hours after the first surgical stage. Only the combination of albumin and terlipressin resulted function improvement and RRT with drawal after three weeks of AKI onset.
Renal dysfunction didn’t affect the liver regeneration and the second stage of ALPPS has been performed in six days after the first one. There were no signs of serious liver synthetic function deterioration, coagulopathy, jaundice or encephalo pathy.
The mechanisms of AKI progression as well as the portal and systemic circulatorychanges after the first stage of ALPPS seem to be similar with hepatorenal syndrome type I. Intra- and postoperative maintenance of physiologic hemodynamics may be the key point for AKI prevention. Norepinephrine and/or terlipressin could be considered as the drugs of choice.
About the Authors
S. E. Voskanyan
State Research Center – A.I. Burnasyan Federal Medical Biophysical Center of the Federal Medical Biological Agency
Russian Federation
Russian Federation
Voskanyan Sergey Eduardovich – Doct. of Med. Sci., Deputy Chief for Surgery, Head of Surgery and Transplantation Center, Head of the Chair of Surgery with the Courses of Oncology, Endoscopy, Surgical Pathology, Clinical Transplantation and Organ Donation.
23, Marshal Novikov str., Moscow, 123098, Russian FederationA. I. Sushkov
State Research Center – A.I. Burnasyan Federal Medical Biophysical Center of the Federal Medical Biological Agency
Russian Federation
Russian Federation
Sushkov Alexander Igorevich – Cand. of Med. Sci., Head of New Surgical Technologies Laboratory, Surgery and Transplantation Center.
23, Marshal Novikov str., Moscow, 123098, Russian FederationA. S. Zhurbin
State Research Center – A.I. Burnasyan Federal Medical Biophysical Center of the Federal Medical Biological Agency
Russian Federation
Russian Federation
Zhurbin Alexey Sergeevich – Junior Researcher, New Surgical Technologies Laboratory, Surgery and Transplantation Center; Postgraduate of the Chair of Surgery with the Courses of Oncology, Endoscopy, Surgical Pathology, Clinical Transplantation and Organ Donation.
23, Marshal Novikov str., Moscow, 123098, Russian FederationE. V. Naydenov
State Research Center – A.I. Burnasyan Federal Medical Biophysical Center of the Federal Medical Biological Agency
Russian Federation
Russian Federation
Naydenov Evgeny Vladimirovich – Cand. of Med. Sci., Surgeon at the Department of Surgery; Senior Researcher of the New Surgical Technologies Laboratory, Surgery and Transplantation Center.
23, Marshal Novikov str., Moscow, 123098, Russian Federation
References
1. Broek M.A., Olde Damink S.W., Dejong C.H., Lang H., Malagó M., Jalan R., Saner F.H. Liver failure after partial hepatic resection: definition, pathophysiology, risk factors and treatment. Liver Int. 2008; 28 (6): 767–780. DOI: 10.1111/j.1478-3231.2008.01777.x.
2. Balzan S., Belghiti J., Farges O., Ogata S., Sauvanet A., Delefosse D., Durand F. The “50-50 criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann. Surg. 2005; 242 (6): 824–828.
3. Vishnevsky V.A., Kovalenko Yu.A., Andreytseva O.I., Ikramov R.Z., Efanov M.G., Nazarenko N.A., Tupikin K.A. Post-resection liver failure: modern problems of definition, epidemiology, pathogenesis, risk assessment, prevention and treatment. Ukrainskii zhurnal khirurgii. 2013; 22 (3): 172–182. (In Russian).
4. Schnitzbauer A.A., Lang S.A., Goessmann H., Nadalin S., Baumgart J., Farkas S.A., Fichtner-Feigl S., Lorf T., Goralcyk A., Hörbelt R., Kroemer A., Loss M., Rümmele P., Scherer M.N., Padberg W., Königsrainer A., Lang H., Obed A., Schlitt H.J. Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings. Ann. Surg. 2012; 255 (3): 405–414. DOI: 10.1097/SLA.0b013e31824856f5.
5. Eshmuminov D., Raptis D.A., Linecker M., Wirsching A., Lesurtel M., Clavien P.A. Meta-analysis of associating liver partition with portal vein ligation and portal vein occlusion for two-stage hepatectomy. Br. J. Surg. 2016; 103 (13): 1768–1782. DOI: 10.1002/bjs.10290.
6. O'Connor M.E., Kirwan C.J., Pearse R.M., Prowle J.R. Incidence and associations of acute kidney injury after major abdominal surgery. Intensive Care Med. 2016; 42 (4): 521–530. DOI: 10.1007/s00134-015-4157-7.
7. Peres L.A., Bredt L.C., Cipriani R.F. Acute renal injury after partial hepatectomy. World J. Hepatol. 2016; 8 (21): 891–901. DOI: 10.4254/wjh.v8.i21.891.
8. Schadde E., Ardiles V., Slankamenac K., Tschuor C., Sergeant G., Amacker N., Baumgart J., Croome K., Hernandez-Alejandro R., Lang H., de Santibaňes E., Clavien P.A. ALPPS offers a better chance of complete resection in patients with primarily unresectable liver tumors compared with conventional-staged hepatectomies: results of a multicenter analysis. World J. Surg. 2014; 38 (6): 1510–1519. DOI: 10.1007/s00268-014-2513-3. PMID: 24748319.
9. Torres O.J., Fernandes Ede S., Oliveira C.V., Lima C.X., Waechter F.L., Moraes-Junior J.M., Linhares M.M., Pinto R.D., Herman P., Machado M.A. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): the Brazilian experience. Arq. Bras. Cir. Dig. 2013; 26 (1): 40–43.
10. Mehta R.L., Kellum J.A., Shah S.V., Molitoris B.A., Ronco C., Warnock D.G., Levin A., Acute Kidney Injury Network. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit. Care. 2007; 11 (2): R31. PMID: 17331245. PMCID: PMC2206446.
11. Abdalla E.K., Barnett C.C., Doherty D., Curley S.A., Vauthey J.N. Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization. Arch. Surg. 2002; 137 (6): 675–680.
12. Vauthey J.N., Chaoui A., Do K.A., Bilimoria M.M., Fenstermacher M.J., Charnsangavej C., Hicks M., Alsfasser G., Lauwers G., Hawkins I.F., Caridi J. Standardized measurement of the future liver remnant prior to extended liver resection: methodology and clinical associations. Surgery. 2000; 127 (5): 512–519.
13. Jarnagin W.R., Gonen M., Fong Y., DeMatteo R.P., Ben-Porat L., Little S., Corvera C., Weber S., Blumgart L.H. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann. Surg. 2002; 236 (4): 397–406.
14. Imamura H., Seyama Y., Kokudo N., Maema A., Sugawara Y., Sano K., Takayama T., Makuuchi M. One thousand fifty-six hepatectomies without mortality in 8 years. Arch. Surg. 2003; 138 (11): 1198–1206.
15. Kowalski H.J., Abelmann W.H. The cardiac output at rest in Laennec's cirrhosis. J. Clin. Invest. 1953; 32 (10): 1025–1033.
16. Abuelo J.G. Normotensive ischemic acute renal failure. N. Engl. J. Med. 2007; 357 (8): 797–805.
17. Davenport A., Farrington K. Dialysis dose in acute kidney injury and chronic dialysis. Lancet. 2010; 375 (9716): 705–706. DOI: 10.1016/S0140-6736(09)62062-6.
18. Davenport A. Continuous renal replacement therapies in patients with liver disease. Semin. Dial. 2009; 22 (2): 169–172. DOI: 10.1111/j.1525-139X.2008.00539.x.
19. Boyer T.D., Sanyal A.J., Garcia-Tsao G., Blei A., Carl D., Bexon A.S., Teuber P., Terlipressin Study Group. Predictors of response to terlipressin plus albumin in hepatorenal syndrome (HRS) type 1: relationship of serum creatinine to hemodynamics. J. Hepatol. 2011; 55 (2): 315–321. DOI: 10.1016/j.jhep.2010.11.020.
20. Gluud L.L., Christensen K., Christensen E., Krag A. Terlipressin for hepatorenal syndrome. Cochrane Database Syst. Rev. 2012; 9: CD005162. DOI: 10.1002/14651858.CD005162.pub3.
21. Sagi S.V., Mittal S., Kasturi K.S., Sood G.K. Terlipressin therapy for reversal of type 1 hepatorenal syndrome: a metaanalysis of randomized controlled trials. J. Gastroenterol. Hepatol. 2010; 25 (5): 880–885. DOI: 10.1111/j.1440-1746.2009.06132.x.
Review
For citations:
Voskanyan S.E., Sushkov A.I., Zhurbin A.S., Naydenov E.V. Acute Kidney Injury after ALPPS Procedure (Case Report). Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2017;22(4):109-115. (In Russ.) https://doi.org/10.16931/1995-5464.20174109-115
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