Perioperative risk factors of acute kidney injury post liver transplantation: a monocentric retrospective cohort study of 260 patients

Aims and Background: Acute kidney injury (AKI) is a major risk factor of
poor outcomes after liver transplantation (LT). AKI is usually attributed to
post-LT events and drug toxicity. Peri-operative risk factors of LT-associated
AKI remain poorly documented, which hampers the development of personalized
preventive strategies.
Methods: AKI was assessed by KDIGO criteria based on creatinine
changes from baseline to day 5 post LT. 260 single first full-size LTs without
any pre-existing renal replacement therapy (RRT) were performed from
2003 to 2018. Incidence of AKI was assessed. Logistic regression determined
the risk factors of KDIGO I and II-III AKI.
Results: Incidence of AKI KDIGO I and II-III was 30% (78/260) and 25.7%
(67/260), respectively. Preoperatively, patients with AKI had higher lab-
MELD and Child-Pugh scores, lower serum fibrinogen and albumin levels.
Donor type, donor hepatectomy and cold ischemic time were similar
between groups. AKI was more frequent in case of marginal donors. LT surgery
was longer in the AKI groups. Needs for per-operative blood transfusions
were higher in the AKI groups. Rate of post-reperfusion syndrome
was higher in AKI groups. Postoperatively, lower hemoglobin levels and
higher INR from day 1-5 were associated with AKI. Peak of transaminases
were not different between AKI versus non-AKI groups. AKI was associated
with longer length of hospital and ICU stays. After multivariate analysis,
blood transfusions and post-reperfusion syndrome were risk factors to
develop KDIGO I AKI. Pre-operative serum levels of fibrinogen and albumin
were risk factors for KDIGO II-III AKI. Finally, “marginal donors” was the
only risk factor for both KDIGO I and II-III AKI.
Conclusions: LT-associated AKI occurs in >50% of cases. Per-operative
hemorrhage and post-operative reperfusion syndrome represent risk factors,
particularly in cases of marginal donors.