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Objective:   This retrospective study investigated the predictive role of serum phosphorus concentration for acute renal failure (ARF), defined by the Risk Injury Failure Loss End-stage kidney disease (RIFLE) criteria, after living-donor liver transplantation (LDLT).Methods:   Perioperative factors, including serum phosphorus concentrations, in LDLT recipients without pre-existing renal dysfunction were retrospectively analysed and compared between patients with or without post-LDLT ARF.Results:   A total of 45 patients out of 350 (12.9%) met the RIFLE ARF criteria and experienced significantly higher postoperative mortality, longer intensive care unit stay and more frequent graft dysfunction than those patients without post-LDLT ARF. Multivariate logistic regression analyses showed that a serum phosphorus concentration ≥ 4.5 mg/dl on postoperative day 1 (relative risk [RR] 5.31; 95% confidence interval [CI] 2.56, 11.03), a preoperative model for end-stage liver disease score = 20 points (RR 4.17, 95% CI 2.04, 8.52), and packed red blood cell transfusion ≥ 10 units (RR 2.55, 95% CI 1.13, 5.88) were independent risk factors for post-LDLT ARF.Conclusions:   Hyper -phosphataemia on postoperative day 1 could be an early and simple indicator of ARF occurrence after LDLT.

Prediction of Newly Developed Acute Renal Failure using Serum Phosphorus Concentrations after Living-donor Liver Transplantation