Incidence and Impact of Acute Kidney Injury after Liver Transplantation: A Meta-Analysis

Charat Thongprayoon; Wisit Kaewput; Natanong Thamcharoen; Tarun Bathini; Kanramon Watthanasuntorn; Ploypin Lertjitbanjong; Konika Sharma; Sohail Abdul Salim; Patompong Ungprasert; Karn Wijarnpreecha; Paul T Kröner; Narothama Reddy Aeddula; Michael A Mao; Wisit Cheungpasitporn

doi:10.3390/jcm8030372

Incidence and Impact of Acute Kidney Injury after Liver Transplantation: A Meta-Analysis

J Clin Med. 2019 Mar 17;8(3):372. doi: 10.3390/jcm8030372.

Authors

Affiliations

¹ Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA. charat.thongprayoon@gmail.com.
² Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand. wisitnephro@gmail.com.
³ Division of Nephrology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA. natthamcharoen@gmail.com.
⁴ Department of Internal Medicine, University of Arizona, Tucson, AZ 85721, USA. tarunjacobb@gmail.com.
⁵ Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY 13326, USA. kanramon@gmail.com.
⁶ Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY 13326, USA. ploypinlert@gmail.com.
⁷ Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY 13326, USA. drkonika@gmail.com.
⁸ Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, MS 39216, USA. sohail3553@gmail.com.
⁹ Clinical Epidemiology Unit, Department of Research and Development, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand. p.ungprasert@gmail.com.
¹⁰ Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL 32224, USA. karnjuve10@gmail.com.
¹¹ Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL 32224, USA. thomaskroner@gmail.com.
¹² Division of Nephrology, Department of Medicine, Deaconess Health System, Evansville, IN 47747, USA. dr.anreddy@gmail.com.
¹³ Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL 32224, USA. mao.michael@mayo.edu.
¹⁴ Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, MS 39216, USA. wcheungpasitporn@gmail.com.

Abstract

Background: The study's aim was to summarize the incidence and impacts of post-liver transplant (LTx) acute kidney injury (AKI) on outcomes after LTx.

Methods: A literature search was performed using the MEDLINE, EMBASE and Cochrane Databases from inception until December 2018 to identify studies assessing the incidence of AKI (using a standard AKI definition) in adult patients undergoing LTx. Effect estimates from the individual studies were derived and consolidated utilizing random-effect, the generic inverse variance approach of DerSimonian and Laird. The protocol for this systematic review is registered with PROSPERO (no. CRD42018100664).

Results: Thirty-eight cohort studies, with a total of 13,422 LTx patients, were enrolled. Overall, the pooled estimated incidence rates of post-LTx AKI and severe AKI requiring renal replacement therapy (RRT) were 40.7% (95% CI: 35.4%⁻46.2%) and 7.7% (95% CI: 5.1%⁻11.4%), respectively. Meta-regression showed that the year of study did not significantly affect the incidence of post-LTx AKI (p = 0.81). The pooled estimated in-hospital or 30-day mortality, and 1-year mortality rates of patients with post-LTx AKI were 16.5% (95% CI: 10.8%⁻24.3%) and 31.1% (95% CI: 22.4%⁻41.5%), respectively. Post-LTx AKI and severe AKI requiring RRT were associated with significantly higher mortality with pooled ORs of 2.96 (95% CI: 2.32⁻3.77) and 8.15 (95%CI: 4.52⁻14.69), respectively. Compared to those without post-LTx AKI, recipients with post-LTx AKI had significantly increased risk of liver graft failure and chronic kidney disease with pooled ORs of 3.76 (95% CI: 1.56⁻9.03) and 2.35 (95% CI: 1.53⁻3.61), respectively.

Conclusion: The overall estimated incidence rates of post-LTx AKI and severe AKI requiring RRT are 40.8% and 7.0%, respectively. There are significant associations of post-LTx AKI with increased mortality and graft failure after transplantation. Furthermore, the incidence of post-LTx AKI has remained stable over the ten years of the study.

Keywords: Acute kidney injury; Acute renal failure; Epidemiology; Incidence; Liver Transplantation; Meta-analysis; Systematic reviews; Transplantation.