Perioperative risk factors of acute kidney injury post liver transplantation: a monocentric retrospective cohort study of 260 patients

peer reviewedAims and Background: Acute kidney injury (AKI) is a major risk factor of poor outcomes after liver transplantation (LT). AKI is usually attributed to post-LT events and drug toxicity. Peri-operative risk factors of LT-associated AKI remain poorly documented, which hampers the development of personalized preventive strategies. Methods: AKI was assessed by KDIGO criteria based on creatinine changes from baseline to day 5 post LT. 260 single first full-size LTs without any pre-existing renal replacement therapy (RRT) were performed from 2003 to 2018. Incidence of AKI was assessed. Logistic regression determined the risk factors of KDIGO I and II-III AKI. Results: Incidence of AKI KDIGO I and II-III was 30% (78/260) and 25.7% (67/260), respectively. Preoperatively, patients with AKI had higher lab- MELD and Child-Pugh scores, lower serum fibrinogen and albumin levels. Donor type, donor hepatectomy and cold ischemic time were similar between groups. AKI was more frequent in case of marginal donors. LT surgery was longer in the AKI groups. Needs for per-operative blood transfusions were higher in the AKI groups. Rate of post-reperfusion syndrome was higher in AKI groups. Postoperatively, lower hemoglobin levels and higher INR from day 1-5 were associated with AKI. Peak of transaminases were not different between AKI versus non-AKI groups. AKI was associated with longer length of hospital and ICU stays. After multivariate analysis, blood transfusions and post-reperfusion syndrome were risk factors to develop KDIGO I AKI. Pre-operative serum levels of fibrinogen and albumin were risk factors for KDIGO II-III AKI. Finally, “marginal donors” was the only risk factor for both KDIGO I and II-III AKI. Conclusions: LT-associated AKI occurs in >50% of cases. Per-operative hemorrhage and post-operative reperfusion syndrome represent risk factors, particularly in cases of marginal donors