title: Acute kidney injury following orthotopic liver transplantation: incidence, risk factors, and effects on patient and graft outcomes.
abstract: BACKGROUND
  Liver transplant recipients frequently develop acute kidney injury (AKI), but the predisposing factors and long-term consequences of AKI are not well understood. The aims of this study were to identify predisposing factors for early post-transplant AKI and the impact of AKI on patient and graft survival and to construct a model to predict AKI using clinical variables.
  
  
  METHODS
  In this 5-year retrospective study, we analysed clinical and laboratory data from 424 liver transplant recipients from our centre.
  
  
  RESULTS
  By 72 h post-transplant, 221 patients (52%) had developed AKI [according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria]. Predisposing factors for development of AKI were female sex, weight (>100 kg), severity of liver disease (Child-Pugh score), pre-existing diabetes mellitus, number of units of blood or fresh frozen plasma transfused during surgery, and non-alcoholic steatohepatitis as the aetiology of end-stage liver disease (P≤0.05). Notably, preoperative serum creatinine (SCr) was not a significant predisposing factor. After fitting a forward stepwise regression model, female sex, weight >100 kg, high Child-Pugh score, and diabetes remained significantly associated with the development of AKI within 72 h (P≤0.05). The area under the receiver operator characteristic curve for the final model was 0.71. The incidence of new chronic kidney disease and requirement for dialysis at 3 months and 1 yr post-transplant were significantly higher among patients who developed AKI.
  
  
  CONCLUSIONS
  Development of AKI within the first 72 h after transplant impacted short-term and long-term graft survival.
authors: Department of Anesthesiology.
authors: I A
authors: IA
authors: Hilmi
authors: Department of Anesthesiology.
authors: D
authors: D
authors: Damian
authors: Department of Medicine.
authors: A
authors: A
authors: Al-Khafaji
authors: Department of Anesthesiology.
authors: R
authors: R
authors: Planinsic
authors: Department of Anesthesiology.
authors: C
authors: C
authors: Boucek
authors: Department of Anesthesiology.
authors: T
authors: T
authors: Sakai
authors: Department of Medicine Department of Biostatistics.
authors: C-C H
authors: CC
authors: Chang
authors: Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA kellumja@upmc.edu.
authors: J A
authors: JA
authors: Kellum
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology*; D000465:Algorithms; D058625:End Stage Liver Disease / Q000601:surgery; D005260:Female; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents
keywords: acute kidney injury; epidemiology; liver transplantation; outcomes