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

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 (rSrO(2)) with conventional diagnostic criteria cystatin C and creatinine concentration in children undergoing pLTx. MATERIAL/METHODS: rSrO(2) 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: rSrO(2) was affected by hemoglobin concentration, bilirubin concentration, and FiO(2). Statistical analysis demonstrated that rSrO(2) 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 rSrO(2) 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 rSrO(2) did not predict the development of postoperative kidney injury. CONCLUSIONS: In children with liver failure undergoing pLTx, a preoperative decrease in rSrO(2) indicates compromised renal function. However, intraoperative rSrO(2) is not predictive of postoperative kidney injury.