Frequency of acute kidney injury in post-liver transplantation and associated factors: a systematic review

Abstract

Introduction:  Acute kidney injury (AKI) is a common complication following liver transplantation (LT). It is associated with factors such as perioperative hemodynamic instability, prolonged surgery, and use of nephrotoxic immunosuppressants, contributing to increased mortality, graft failure, and extended hospital stay.

Methods:  A systematic search of the databases PubMed, Embase, and the Cochrane Central Register of Controlled Trials was conducted to identify observational studies with samples of at least 50 patients aged 18 years or older who underwent LT and analyzed AKI incidence post-procedure and assess long-term renal outcomes.

Results:  A total of 30 studies with a total of 13,653 patients were included. The incidence of AKI post-LT was 46% (95% CI: 45%–47%), with significant variation across studies (24% to 84%) and high heterogeneity (I² = 97%, p < 0.001). The pooled incidence of dialysis requirement post-LT was 10% (95% CI: 9%–11%), also highly variable across studies (2% to 36%) with high heterogeneity (I² = 95%, p < 0.001). Common postoperative complications included prolonged mechanical ventilation, graft dysfunction, infections, and hypertension (HTN). Furthermore, the analysis highlighted significant AKI risk factors, such as HTN, diabetes, hyperlactatemia, hyperbilirubinemia, and prolonged hospitalization.

Conclusion:  AKI and dialysis requirements are frequent complications following LT. Multiple risk factors, including HTN, diabetes, and prolonged hospitalization, are associated with an increased risk of AKI post-LT. The high incidence of AKI underscores the importance of early identification of at-risk patients and multidisciplinary approaches to improve outcomes.

Keywords:
Acute Kidney Injury; Kidney Failure; Liver Transplantation; Systematic Review