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

Abstract

Background 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. We aimed to identify modifiable risk factors of AKI after LT. Methods A 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. Results Sixty-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. Conclusions Effective 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 registration The protocol for this systematic review is registered with PROSPERO (No. CRD42020166918).

Risk factors of the post-reperfusion syndrome during orthotopic liver transplantation: a clinical observational study

“…One of the important findings in our study was that more renal dysfunction required RRT in the PRS group. In a meta-analysis performed by Zhou et al PRS was identified as one of the AKI risk factors after LT [ 28 ]. Hemodynamic instability during PRS has a major effets on decreased renal blood flow and renal tissue hypoxia, which can play an important role in the development of AKI after LT, on the other hand, PRS not only releases cold and acidotic components from the graft but also releases pro-inflammatory cytokines that trigger the inflammatory response and cause renal tubular injury [ 28 ] .In terms of the need for surgical revision, in the initial period after transplantation, although in our study, bleeding was the most common reason for the need for reoperation in both groups, there was significant difference between them.…”

Risk factors and prediction of acute kidney injury after liver transplantation: Logistic regression and artificial neural network approaches

“…Regarding the risk factors identified in the present research, several other authors have already described that higher MELD scores[ 37 ] were associated with AKI after LT[ 20 , 38 ]. Xu et al [ 21] showed that MELD score > 25 was a predictor of AKI, and in patients with MELD scores > 30, the most required RRT[ 11 , 39 ]. Moreover, in the cirrhosis scenario, the functional renal disorders can be added as risk factors for AKI, such as recipient HRS[ 11 , 23 , 40 ].…”

“…Xu et al [ 21] showed that MELD score > 25 was a predictor of AKI, and in patients with MELD scores > 30, the most required RRT[ 11 , 39 ]. Moreover, in the cirrhosis scenario, the functional renal disorders can be added as risk factors for AKI, such as recipient HRS[ 11 , 23 , 40 ]. Donor marginal liver grafts of ECD were identified elsewhere as a strong predictor of PGD[ 24 - 26 ] and post-LT AKI[ 20 ].…”

“…Among the possible complications of complex abdominal and liver procedures, acute kidney injury (AKI) should be considered a major cause of postoperative morbidity and mortality[ 1 - 6 ]. Updated data report a 0.9%-17.9% incidence of AKI after liver resection[ 7 - 9 ], and 4%-94% after LT[ 10 , 11 ], either living-donor (LDLT) or deceased-donor LT (DDLT). Although there is a lack of a reported standard definition of postoperative AKI[ 12 ] after DDLT, it is of fundamental importance to identify patients at risk for AKI after LT, ideally by the set of preoperative clinical evaluation, as well as by the complementary information of the intraoperative period, thus enabling the adoption of preventive measures or early therapies for AKI in the postoperative period.…”

Abdominal Organ Transplantation: Noteworthy Literature in 2021

“…These intraoperative factors could be the target of possible interventions and prevention strategies for transplant anesthesiologists. 50 The vasoconstrictor terlipressin is used for type 1 hepatorenal syndrome (HRS-1) in many parts of the world outside of the US and is part of the clinical practice guidelines in Europe. Wong and collaborators completed the CONFIRM Study, a phase 3 trial to confirm the efficacy and safety of terlipressin plus albumin in adults with HRS-1.…”