Yuchen Dong, Li Pang, Chao Liu, Wenrui Wu
Post-LT AKI was common and associated with increased 1-year mortality. Surgical technique, donor ICU stay, donor weight, operative time, and intraoperative hypotension were independently associated with AKI risk. These findings highlight potentially modifiable perioperative factors relevant to post-LT AKI risk.
BACKGROUND: Acute kidney injury (AKI) is frequent after liver transplantation (LT). We evaluated its incidence, risk factors, and survival impact.
METHODS: We retrospectively analyzed 341 adult recipients who underwent conventional open LT between January 2019 and January 2024. Patients undergoing nonstandard implantation techniques, laparoscopic-assisted LT, combined liver-kidney transplantation, or retransplantation, as well as those with pretransplant eGFR <30 mL/min/1.73 m2 or incomplete data, were excluded.
RESULTS: AKI occurred in 54.3% (stage 1, 39.6%; stage 2, 9.4%; stage 3, 5.3%). The modified piggyback technique was associated with a lower incidence of AKI than classical caval replacement (47.1% vs 61.5%, P = .01). Multivariable analysis identified surgical technique, donor ICU stay, donor weight, operative time, and cumulative duration of MAP <65 mm Hg as independent factors associated with AKI. One-year survival was lower in the AKI group (82.4% vs 93.3%; P = .003).
CONCLUSIONS: Post-LT AKI was common and associated with increased 1-year mortality. Surgical technique, donor ICU stay, donor weight, operative time, and intraoperative hypotension were independently associated with AKI risk. These findings highlight potentially modifiable perioperative factors relevant to post-LT AKI risk.