Acute Kidney Injury After Liver Transplantation: Incidence, Risk Factors, and Outcomes

Abstract

Introduction: Although numerous risk factors for acute kidney injury (AKI) have been identified, their cumulative impact remains unclear. This study aimed to identify perioperative risk factors for early post-transplant AKI on patients and outcomes and to predict AKI using clinical variables. Material and Methods: A single-center, retrospective cohort study involving 34 pediatric patients and 31 adults who underwent LT between 2015 and 2017. Results: AKI occurred in 16 (47%) pediatric patients during the first-week post-LT with stage 1, stage 2, and stage 3 AKI frequencies of 43.8, 50, and 6.3%, respectively. Renal replacement therapy (RRT) was initiated in 18.8% of pediatric LT patients. Preoperative liver enzymes and the etiology of liver failure are the most critical factors affecting AKI in pediatric LT patients. AKI occurred in 15 (48%) adult patients during the first-week post-LT with stage 1, stage 2, and stage 3 AKI frequencies of 43%, 21%, and 21%, respectively. The requirement for RRT was seen in 43% of adult LT patients. There were also statistical differences between the two groups regarding the number of patients with preoperative kidney dysfunction (20-80%, p=.047) and mortality rates (6-31 %, p=.047). In adult patients who developed post-LT AKI compared with those who did not develop post-LT AKI, they had significantly higher levels of serum creatinine (sCr) (1.9±1.9 mg/dL vs. 0.7±0.1 mg/dL, p=.013), were given lower amounts of crystalloids (73±32 mL/kg vs. 106±33 mL/kg, p=.018) and had lower urine output (UO) intraoperatively (11±9 mL/kg vs. 20±9 mL/kg, p=.047). There was a higher mortality rate in adult patients with post-LT AKI (89 vs. 11%, p=.003). Conclusion: The results of our study contribute to raising awareness of the potential risk factors associated with preoperative evaluation, intraoperative and postoperative close follow-up, careful anesthesia management, and early onset of post-LT AKI.