Association Between Left Ventricular Geometry and Early Acute Kidney Injury Following Orthotopic Liver Transplantation.

BACKGROUND: Acute kidney injury (AKI) after liver transplantation is frequent and associated with worse outcomes. Structural cardiac remodeling has been linked to postoperative AKI in other surgical populations, but its role in liver transplant recipients with preserved cardiac and renal function is unclear. We examined the association between left ventricular geometry and postoperative AKI. METHODS: In this single-center retrospective cohort study, 409 adult deceased-donor liver transplant recipients (2014-2020) were analyzed. Patients with advanced chronic kidney disease, hepatorenal syndrome, systolic dysfunction, or diastolic dysfunction were excluded. Preoperative echocardiograms were reviewed to determine relative wall thickness (RWT), left ventricular mass index (LVMI), and ventricular geometry (normal, concentric remodeling, concentric hypertrophy, eccentric hypertrophy). The primary outcome was AKI within 7 days, defined by Kidney Disease Improving Global Outcomes criteria. Multivariable logistic regression adjusted for perioperative covariates. RESULTS: The cohort was 63% male, with a median age of 57 years. AKI occurred in 189 patients (46.2%), including 103 stage 1, 47 stage 2, and 39 stage 3 cases. RWT, LVMI, and ventricular geometry were similar between groups. In adjusted analyses, ventricular geometry, RWT, and LVMI were not associated with AKI. Increased cold ischemic time and transfusion burden were independently associated with AKI. CONCLUSIONS: Left ventricular remodeling was not associated with postoperative AKI. Operative and perioperative factors appear to play a more substantial role.