Incidence and Risk Factors of Acute Kidney Injury following Orthotopic Liver Transplantation

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Tanittha Angkurawanit
Manasnun Kongwibulwut

Abstract

Background:Acute kidney injury (AKI) commonly occurs during post-liver transplant period. However, the incidence varies largely between studies and the predisposing factors are not well understood. Objectives: This study aims to identify the incidence and risk factors contributing to early AKI following liver transplantation. Methods: Electronic medical records of 87 patients underwent orthotopic liver transplantation at King Chulalongkorn Memorial Hospital during January 2014 to October 2019 were retrospectively reviewed. Primary endpoint was the incidence of AKI which was defined according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. Secondary endpoints were the need for renal replacement therapy (RRT), length of hospital stay, and factors associated with post-liver transplant AKI. Data were collected and analyzed using univariate and multiple logistic regression with stepwise variable selection to identify risk factors for AKI.Results:AKI occurred in 43 patients (49.4%). Independent factors found to be associated with post-liver transplant AKI were decreased intraoperative urine output, longer duration of postoperative dopamine infusion, and higher dose of postoperative diuretics (P=0.002, P=0.019, and P<0.001, respectively). In AKI group, 2 patients required RRT (4.8%). When comparing AKI to non-AKI groups, duration of length of hospital stay was not significantly different (7.7 vs 11.1 days, respectively, P=0.86). There was no mortality in our study. Conclusions: The incidence of AKI following orthotopic liver transplantation was 49.4%. Decreased intraoperative urine output, prolonged duration of postoperative dopamine infusion, and higher dose of postoperative diuretics were independently associated with the development of AKI. AKI was not associated with prolonged hospitalization.

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