Predictive role of vitamin B12 in acute kidney injury in living donor liver transplantation: a propensity score matching analysis

• Published in: BMJ open Vol. 10; no. 11; p. e038990
• Main Authors: Park, Jaesik, Choi, Jung Hee, Choi, Ho Joong, Hong, Sang Hyun, Park, Chul Soo, Choi, Jong Ho, Chae, Min Suk
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 14.11.2020; BMJ Publishing Group
• Series: Original research
• Subjects: Age; Anesthesia; Blood; Blood platelets; Body mass index; Creatinine; Diabetes; Hepatitis; Hospitals; Kidney diseases; Laboratories; Liver diseases; Liver transplants; Malnutrition; Medical prognosis; Patients; Postoperative period; Surgery; Urine; Vital signs; Vitamin B; Vitamin deficiency
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2020-038990

ObjectivesWe examine the association between vitamin B12 level and risk for acute kidney injury (AKI) in patients undergoing living donor liver transplantation (LDLT).DesignRetrospective observational cohort study.SettingUniversity hospital, from January 2009 to December 2018.ParticipantsA total of 591 patients who underwent elective LDLT were analysed in this study. Those with a preoperative history of kidney dysfunction, vitamin B12 supplementation due to alcoholism, low vitamin B12 (<200 pg/mL) or missing laboratory data were excluded.Primary and secondary outcome measuresThe population was classified into AKI and non-AKI groups according to Kidney Disease Improving Global Outcomes (KDIGO) criteria, and associations between perioperative factors and AKI were analysed. After 1:1 propensity score (PS) matching, the association between high vitamin B12 (>900 pg/mL) and postoperative AKI was evaluated.ResultsPreoperative vitamin B12 was higher in the AKI group. Potentially significant perioperative factors from univariate analyses were entered into multivariate analyses, including preoperative factors (vitamin B12, diabetes), intraoperative factors (hourly urine output) and donor graft fatty change in LDLT patients. PS matching analyses with adjustment using PS revealed that high serum vitamin B12 (>900 pg/mL) was associated with risk for AKI, and the risk was 2.8-fold higher in patients with high vitamin B12 than in those with normal vitamin B12. Higher vitamin B12 was also related to a higher AKI stage. In addition, inflammatory factors (C reactive protein, white blood cells and albumin) were associated with vitamin B12 level.ConclusionsOur study may improve the accuracy of predicting postoperative AKI by introducing preoperative vitamin B12 into risk assessments for patients undergoing LDLT.