Modifiable risk factors of acute kidney injury after liver transplantation: a systematic review and meta-analysis

Jian Zhou,Jian Zhou,Lin Lyu,Lin Lyu,Xiaojun Ma,Xiaojun Ma,Guishen Miao,Guishen Miao,Xueying Zhang,Xueying Zhang,Haichen Chu

doi:10.1186/s12882-021-02360-8

Abstract

BackgroundAcute kidney injury (AKI) is a common and critical complication of liver transplantation (LT), which is associated with increased morbidity, mortality and health care cost. We aimed to identify modifiable risk factors of AKI after LT.MethodsA literature search of Pubmed, EMBASE and Cochrane Databases was performed to identify studies investigating risk factors of AKI after LT. The Newcastle-Ottawa Scale was used to rate study quality. Effect size and 95% confidence interval were pooled using a random-effect model with inverse-variance method.ResultsSixty-seven articles with 28,844 patients were included in the meta-analysis. Seventeen modifiable risk factors were found, including overweight, preoperative use of diuretic, preoperative anemia, donation after cardiac death organ, donor BMI ≥ 30 kg/m2, ABO-incompatible LT, low graft to recipient body weight ratio, intraoperative hypotension, major bleeding, intraoperative use of vasopressor, large RBC transfusion, postreperfusion syndrome, postoperative use of vasopressors, overexposure to calcineurin inhibitor, calcineurin inhibitor without mycophenolate mofetil, graft dysfunction and infection. A total of 38 articles were included in the systematic review, in which 8 modifiable risk factors and 1 protective factor were additionally associated in single studies with the incidence of AKI after LT.ConclusionsEffective interventions based on identified modifiable risk factors in the perioperative management and graft allocation and preservation may be promising to reduce the incidence of AKI after LT.Trial registrationThe protocol for this systematic review is registered with PROSPERO (No. CRD42020166918).

Highlights

Acute kidney injury (AKI) is a common and critical complication of liver transplantation (LT), which is associated with increased morbidity, mortality and health care cost
A total of 15 risk factors and 1 protective factor were associated with AKI after LT (Fig. 5)
With regard to surgical factors, our study indicates that intraoperative hypotension, major bleeding, use of vasopressor, large red blood cell (RBC) transfusion, and postreperfusion syndrome (PRS) during operation are associated with increased risk of AKI after LT

Summary

Introduction

Acute kidney injury (AKI) is a common and critical complication of liver transplantation (LT), which is associated with increased morbidity, mortality and health care cost. The definition of AKI has evolved rapidly from Risk, Injury, Failure, Loss of kidney function, End-stage renal. Zhou et al BMC Nephrology (2021) 22:149 respectively [3] These numbers are even higher for patients undergoing liver transplantation (LT), where the incidence of AKI and severe AKI requiring renal replacement therapy (RRT) after LT is up to 40.8 and 7.0%, respectively [4]. Previous studies have reported that AKI after LT is associated with immediate complications including volume overload, metabolic acidosis, and electrolyte disturbances, and an increased rate of inferior long-term outcomes such as mortality, graft loss, infection, chronic kidney disease (CKD), prolonged stay in the intensive care unit (ICU), and augmented hospital costs [5,6,7]. Investigating the modifiable risk factors of AKI after LT is of vital importance

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