Introduction: Acute kidney injury (AKI) is a common postoperative complication following liver transplantation (LT) with an incidence ranging from 40% to 70%. The aim of this study was to analyze the incidence of AKI following LT by using KDIGO criteria and compare patients who developed AKI with those who did not.
Materials and Methods: We retrospectively analyzed the data of 65 consecutive patients who underwent LT in Baskent University Hospital between January 2015 to May 2017. Demographic, preoperative, and intraoperative data were collected.
Results: The median age of the overall population was 25±24 years and 12 (38%) of them were female. There were 34 pediatric patients younger than 18 years. This group had a median age of 64±72 months and 14 (41%) of them were female. AKI occurred in 16 (47%) pediatric patients during the first week following LT with stage 1, stage 2, and stage 3 AKI frequencies of 43.8%, 50 %, and 6.3%, respectively. When compared with those who developed AKI, the median age, body weight, MELD scores (model for end-stage liver disease), PELD scores (pediatric end-stage liver disease), graft recipient ratio were similar between the pediatric patients who did not develop AKI. Among living donors, significantly lower percentage of patients developed AKI (39% vs 61%, p=.018).There were also statistical differences between the two groups in terms of number of patients who had preoperative kidney dysfunction (80% vs 20%, p=.047) and mortality rates (31% vs 6 %, p=.047). Renal replacement therapy (RRT) was initiated in 18.8% of pediatric liver transplant recipients.
The percentage of patients older than 18 years were 48% (n=31). This group had a median age of 46±17 years and 7 (23%) of them were female. AKI occurred in 15 (48%) adult patients during the first week following LT with stage 1, stage 2, and stage 3 AKI frequencies of 43%, 21%, and 21%, respectively. When compared with those who developed AKI, the median age, body weight, and MELD scores were similar between the pediatric patients who did not develop AKI. Compared with those who did not develop AKI postoperatively, those who did had significantly lower levels of creatinine (1.9±1.9 mg/dl vs 0.7±0.1 mg/dl, p=.013), given higher amounts of crystalloids (73±32 ml/kg vs 106±33 ml/kg, p=.018) and had lower urine output intraoperatively (11±9 ml/kg vs 20±9 ml/kg, p=.018). Requirement for RRT was seen in 43% of adult liver transplant recipients. There was a higher mortality rate in patients with AKI following LT (89% vs 11%, p=.003).
Conclusion: Our results indicates that AKI occurred in more than half of adult patients after LT and about half of pediatric liver transplant recipients according to KDIGO criteria in our cohort. Mortality of patients with AKI was significantly higher for both adult and pediatric groups.