title: Impact of acute kidney injury following liver transplantation on long-term outcomes.
abstract: The incidence of acute kidney injury (AKI) after liver transplantation (LTx) ranges from 17% to 94%. AKI is associated with prolonged hospitalization and increased early mortality. In our cohort study, we examined the impact of AKI on long-term patient survival and on the incidence of stage 4-5 chronic kidney disease (CKD).
  
  
  
  We studied 491 LTx recipients at a single center between 1990 and 2012. We identified 278 pts (56.6%) with AKI defined as either an increase in serum creatinine (SCr) ≥26.5 μmol/L within 48 hour or elevation in SCr 1.5× baseline within 7 days (KDIGO criteria).
  
  
  
  In a multivariable Cox proportional hazards model, survival was worse in patients with AKI (HR: 1.41, 95% CI 1.03-1.92). Severe (stage 3) AKI was associated with worse patient survival (HR: 2.29, 95% CI 1.46-3.58). The risk of developing stage 4-5 CKD was also higher in patients with AKI (17.5% vs 9.1%) with a HR of 2.39 (95% CI 1.27-4.47). Delaying initiation of calcineurin inhibitors >48H was not associated with a decreased risk of CKD.
  
  
  
  Our findings suggest that AKI after LTx is associated with poor long-term outcomes, including worse survival and higher incidence of CKD stage 4-5. Strategies to prevent and manage LTx patients with AKI need to be developed.
authors: Division of Nephrology, Multi-Organ Transplant Program, McGill University Health Center, Montreal, QC, Canada.
authors: Emilie
authors: E
authors: Trinh
authors: Division of Nephrology, Multi-Organ Transplant Program, McGill University Health Center, Montreal, QC, Canada.
authors: Ahsan
authors: A
authors: Alam
authors: Division of General Surgery, Multi-Organ Transplant Program, McGill University Health Center, Montreal, QC, Canada.
authors: Jean
authors: J
authors: Tchervenkov
authors: Division of Nephrology, Multi-Organ Transplant Program, McGill University Health Center, Montreal, QC, Canada.
authors: Marcelo
authors: M
authors: Cantarovich
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality*; D002170:Canada / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors
keywords: acute kidney injury; calcineurin inhibitor; chronic kidney disease; liver transplantation; survival