Acute kidney injury following orthotopic liver transplantation: incidence, risk factors, and effects on patient and graft outcomes

Br J Anaesth. 2015 Jun;114(6):919-26. doi: 10.1093/bja/aeu556. Epub 2015 Feb 10.


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.

Keywords: acute kidney injury; epidemiology; liver transplantation; outcomes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury / epidemiology
  • Acute Kidney Injury / etiology*
  • Algorithms
  • End Stage Liver Disease / surgery
  • Female
  • Graft Survival*
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Incidence
  • Liver Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Postoperative Complications / epidemiology
  • Postoperative Complications / therapy*
  • Predictive Value of Tests
  • Retrospective Studies
  • Risk Factors
  • Survival Analysis
  • Treatment Outcome


  • Immunosuppressive Agents