Incidence and Impact of Acute Kidney Injury after Liver Transplantation: A Meta-Analysis.

Charat Thongprayoon,Natanong Thamcharoen,Narothama Aeddula,Michael Mao,Tarun Bathini,Wisit Cheungpasitporn,Konika Sharma,Paul Kröner,Sohail Salim,Patompong Ungprasert,Wisit Kaewput,Karn Wijarnpreecha,Ploypin Lertjitbanjong,Kanramon Watthanasuntorn

doi:10.3390/jcm8030372

Abstract

Background: The study’s aim was to summarize the incidence and impacts of post-liver transplant (LTx) acute kidney injury (AKI) on outcomes after LTx. Methods: A literature search was performed using the MEDLINE, EMBASE and Cochrane Databases from inception until December 2018 to identify studies assessing the incidence of AKI (using a standard AKI definition) in adult patients undergoing LTx. Effect estimates from the individual studies were derived and consolidated utilizing random-effect, the generic inverse variance approach of DerSimonian and Laird. The protocol for this systematic review is registered with PROSPERO (no. CRD42018100664). Results: Thirty-eight cohort studies, with a total of 13,422 LTx patients, were enrolled. Overall, the pooled estimated incidence rates of post-LTx AKI and severe AKI requiring renal replacement therapy (RRT) were 40.7% (95% CI: 35.4%–46.2%) and 7.7% (95% CI: 5.1%–11.4%), respectively. Meta-regression showed that the year of study did not significantly affect the incidence of post-LTx AKI (p = 0.81). The pooled estimated in-hospital or 30-day mortality, and 1-year mortality rates of patients with post-LTx AKI were 16.5% (95% CI: 10.8%–24.3%) and 31.1% (95% CI: 22.4%–41.5%), respectively. Post-LTx AKI and severe AKI requiring RRT were associated with significantly higher mortality with pooled ORs of 2.96 (95% CI: 2.32–3.77) and 8.15 (95%CI: 4.52–14.69), respectively. Compared to those without post-LTx AKI, recipients with post-LTx AKI had significantly increased risk of liver graft failure and chronic kidney disease with pooled ORs of 3.76 (95% CI: 1.56–9.03) and 2.35 (95% CI: 1.53–3.61), respectively. Conclusion: The overall estimated incidence rates of post-LTx AKI and severe AKI requiring RRT are 40.8% and 7.0%, respectively. There are significant associations of post-LTx AKI with increased mortality and graft failure after transplantation. Furthermore, the incidence of post-LTx AKI has remained stable over the ten years of the study.

Highlights

Acute kidney injury (AKI) is associated with high mortality worldwide (1.7 million deaths per year) [1,2,3,4]
After the exclusion of 1994 articles based on title and abstract for clearly not fulfilling inclusion criteria on the basis of type of article, patient population, study design, or outcome of interest, and 417 due to being duplicates, 114 articles were left for full-length review
There was no significant publication bias in meta-analysis assessing the incidence of post-LTx acute kidney injury (AKI), p-value = 0.12. In this meta-analysis, we found that AKI and severe AKI requiring renal replacement therapy (RRT) after LTx are common, with an incidence of 40.8% and 7.0%, respectively

Summary

Introduction

Acute kidney injury (AKI) is associated with high mortality worldwide (1.7 million deaths per year) [1,2,3,4]. The pooled estimated incidence rates of post-LTx AKI and severe AKI requiring renal replacement therapy (RRT) were 40.7% (95% CI: 35.4%–46.2%) and 7.7% (95% CI: 5.1%–11.4%), respectively. Post-LTx AKI and severe AKI requiring RRT were associated with significantly higher mortality with pooled ORs of 2.96 (95% CI: 2.32–3.77) and 8.15 (95%CI: 4.52–14.69), respectively. Compared to those without post-LTx AKI, recipients with post-LTx AKI had significantly increased risk of liver graft failure and chronic kidney disease with pooled ORs of 3.76 (95% CI: 1.56–9.03) and 2.35 (95% CI: 1.53–3.61), respectively.

Methods

Results

Conclusion