Background Impaired postoperative renal function is associated with increased morbidity
and mortality after liver resection. The role of impaired renal function in the two-stage
hepatectomy setting of associating liver partition and portal vein ligation for staged
hepatectomy (ALPPS) is unknown. Methods An international multicenter cohort of ALPPS
patients captured in the ALPPS Registry was analyzed. Particular attention was drawn
to the renal function in the interstage interval to determine outcome after stage
2 surgery. Interstage renal impairment (RI) was defined as an increase of serum creatinine
of >= 0.3 mg/dl referring to a preoperative value or an increase of serum creatinine
of >= 1.5x of the preoperative value on the fifth postoperative day after stage 1.
Results A total of 705 patients were identified of which 7.5% had an interstage RI.
Patients developing an interstage RI were significantly older. During stage 1, a longer
operation time, higher rate of intraoperative transfusions, and additional procedures
were observed in patients that developed interstage RI. After stage 1, interstage
RI patients had more major complications and higher interstage mortality (1% vs. 8%,p<
0.001). Furthermore, these patients developed more and severe complications after
completion of stage 2. Mortality of patients with interstage RI was 38% vs. 8% without
interstage RI. In 41% of patients with interstage RI, the renal function recovered
before stage 2; however, the mortality after stage 2 remained 28% in those patients.
Risk factors for the development of an interstage RI were age over 67 years, prolonged
operative time, and additional procedure during stage 1. Conclusion This study shows
that interstage RI is a predictor for interstage and post-stage 2 morbidity and perioperative
mortality. The causality of impaired renal function on outcome, however, remains unknown.
Interstage RI may directly cause adverse outcome but may also be a surrogate marker
for major complications.
