Frequency of acute kidney injury in post-liver transplantation and associated factors: a systematic review.
Moura, A. F., et al.J Bras Nefrol. 2025 Oct-Dec;47(4):e20250022.
Aims
They aim to quantify the incidence of AKI after liver transplantation (LT), the need for dialysis, and identify associated risk factors and complications.
Interventions
No interventional studies, simply a systematic review/meta-analysis of observational cohorts.
Participants
30 studies, totalling 13,653 adult LT recipients (studies published 2019–2024). Most used KDIGO criteria, with a minority using AKIN/RIFLE.
Outcomes
Primary outcomes pooled AKI incidence after LT and pooled incidence of post-LT dialysis. Frequently reported associated factors/complications: male sex, diabetes, hypertension, higher MELD/APACHE/SAPS scores, peri-operative hypotension/vasopressors, longer operative/anhepatic time, high blood loss/transfusion, hyperlactataemia, hypoalbuminaemia, and infectious/graft-related complications.
Follow-up
Varied across included studies.
CET Conclusions
The authors present a methodologically sound systematic review and meta-analysis suggests AKI affects nearly half of LT recipients (46%, 95% CI 45–47%, with high heterogeneity, I²=97%) and ~1 in 10 require dialysis (10%, 95% CI 9–11%, and ²=95%), reinforcing AKI as a major, multifactorial postoperative risk. They find clear peri-operative contributors: haemodynamic instability, operative duration, transfusion burden, while these are well known, there is benefit of providing robust systematic evidence across many studies for the statistics behind AKI and dialysis as well as operative risk factors which to some extent can be managed. Overall, the evidence quality is constrained by observational designs, heterogeneous AKI definitions (though KDIGO-only sensitivity analyses supported robustness), and high between-study heterogeneity. However, methodological quality was assessed with the Newcastle–Ottawa Scale and most studies were of moderate to high quality. Clinically, findings support, and add statistical weight to practice which is generally aimed for already, rigorous peri-operative haemodynamic management, early risk stratification (KDIGO/ISN guidance), and minimisation of nephrotoxins to mitigate AKI risk after LT.
Trial registration
PROSPERO - CRD42024583773