A Simplified Clinical Risk Score to Predict Acute Kidney Injury After Living-Donor Liver Transplantation.

Abstract

Background: We identified the incidence and risk factors for acute kidney injury (AKI) after living donor liver transplantation and constructed a simplified risk scoring model to determine a clinical risk score for the prediction of AKI. Methods: We retrospectively reviewed 525 cases of thoracic aortic surgery. Multivariate logistic regression analysis was used to evaluate risk factors for predicting AKI defined by RIFLE criteria. A scoring model was developed in a derivation cohort (n = 300), and was validated on the remaining patients. The scoring model was developed with a score based on regression β-coefficient, and was compared with previous model as measured by the area under the ROC curve (AUC). Results: The incidence of AKI was 55.7%, and 18.0% required renal replacement therapy. Independent risk factors for AKI were MELD score ≥20, Diabetes mellitus, graft weight-to-recipient body weight ratio < 0.7%, blood loss/body weight > 60ml/kg, cold ischemic time ≥80 min, overexposure to calcineurin inhibitor, hypoalbuminemia, intraoperative furosemide dose > 2 mg/kg, and combined use of mycophenolate mofetil. The clinical score was valid in predicting AKI, and the AUC was 0.78 (95% CI: 0.71 to 0.82), and was similar to that in the validation cohort 0.77 (95% CI: 0.72 to 0.82; P= 0.98). Our risk scoring model showed a better performance compared with previously reported model. Conclusions: Our risk scoring model would provide useful information about the risk of postoperative AKI in patients undergoing liver transplantation.