• 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, and Wisit Cheungpasitporn.
• Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA. charat.thongprayoon@gmail.com.
• J Clin Med. 2019 Mar 17; 8 (3).

BackgroundThe study's aim was to summarize the incidence and impacts of post-liver transplant (LTx) acute kidney injury (AKI) on outcomes after LTx.MethodsA 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).ResultsThirty-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.ConclusionThe 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.

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