Renal outcomes following left renal vein harvest for venous reconstruction during pancreas and liver surgery

• Published in: HPB (Oxford, England) Vol. 21; no. 1; pp. 114 - 120
• Main Authors: Loveday, Benjamin P.T., Dib, Martin J., Sequeira, Sangita, Alotaiby, Nouf, Visser, Robin, Barbas, Andrew S., Wei, Alice C., Cleary, Sean P., Moulton, Carol-Anne, Gallinger, Steven, Greig, Paul D., McGilvray, Ian D.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.01.2019
• Subjects: Acute Kidney Injury - diagnosis; Acute Kidney Injury - etiology; Acute Kidney Injury - physiopathology; Adolescent; Adult; Aged; Aged, 80 and over; Biomarkers - blood; Creatinine - blood; Female; Glomerular Filtration Rate; Hepatectomy - adverse effects; Humans; Male; Middle Aged; Pancreatectomy - adverse effects; Pancreaticoduodenectomy - adverse effects; Renal Insufficiency, Chronic - diagnosis; Renal Insufficiency, Chronic - etiology; Renal Insufficiency, Chronic - physiopathology; Renal Veins - transplantation; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Tissue and Organ Harvesting - adverse effects; Treatment Outcome; Young Adult
• ISSN: 1365-182X; 1477-2574
• DOI: 10.1016/j.hpb.2018.07.015

The left renal vein (LRV) may be used for venous reconstruction during hepato-pancreato-biliary (HPB) surgery, although concerns exist about compromising renal function. This study aimed to determine renal outcomes following LRV harvest during HPB resections. Circumferential PV/SMV resections from 2008 to 2014 were included within two groups (LRV harvest, Control). Absolute and change in Creatinine (Cr) and estimated GFR (eGFR), and rates of acute kidney injury (AKI) and chronic kidney disease (CKD), were compared. Multivariate logistic regression analyses were performed. 76 patients were included (LRV n = 17, Control n = 59). Median Cr and eGFR did not change within groups, although change in eGFR differed between groups at postoperative day (POD) 3 (−4.3 vs. 12.8, p = 0.0035) and 7 (−1.8 vs. 12.4, p = 0.0074). AKI occurred more frequently in the LRV group at POD1 (5/17 vs. 4/59, p = 0.023) and POD3 (5/17 vs. 3/59, p = 0012), with no difference in CKD between groups (2/11 vs. 5/33 at 3 months, p = 0.99). LRV harvest was an independent risk factor for AKI at POD1 and POD3, but not thereafter. Patients who undergo LRV harvest experience a higher rate of AKI in the first three post-operative days. LRV harvest during pancreas resection does not impact on long-term renal function.