• Silvia Fiorelli, Giandomenico Biancofiore, Paolo Feltracco, Bruna Lavezzo, Andrea DE Gasperi, Livia Pompei, Lucia Masiero, Silvia Testa, Andrea Ricci, Della RoccaGiorgioGDepartment of Medical Area, University of Udine, Udine, Italy., and OLTx Study Group.
• Department of Anesthesiology and Intensive Care, Sapienza University, Rome, Italy - silvia.fiorelli@uniroma1.it.
• Minerva Anestesiol. 2022 Apr 1; 88 (4): 248-258.

BackgroundAcute kidney injury (AKI) represents a frequent complication after orthotopic liver transplantation (OLT). This study aimed to evaluate early postoperative AKI incidence during the first 72 h after OLT, perioperative risk factors, and AKI impact on survival.MethodsFrom January 2011 to December 2013, 1681 patients underwent OLT in 19 centers and were enrolled in this prospective cohort study.ResultsAccording to RIFLE criteria, AKI occurred in 367 patients, 21.8% (R: 5.8%, I: 6.4%, F: 4.8%, L: 4.8%). Based on multivariate analysis, intraoperative risk factors for AKI were: administration of 5-10 RBCs (OR 1.8, 95% CI 1.3-2.7), dopamine use (OR 1.6, 95% CI 1.2-2.3), post-reperfusion syndrome (OR 1.5, 95% CI 1.0-2.3), surgical complications (OR 2.0, 95% CI 1.3-3.0), and cardiological complications (OR 2.2, 95% CI 1.2-4.0). Postoperative risk factors were: norepinephrine (OR 1.4, 95% CI 1.0-2.0), furosemide (OR 4.2, 95% CI 3.0-5.9), more than 10 RBCs transfusion, (OR 3.7, 95% CI 1.4-10.5), platelets administration (OR 1.6, 95% CI 1.1-2.4), fibrinogen administration (OR 3.0, 95% CI, 1.5-6.2), hepatic complications (OR 4.6, 95% CI 2.9-7.5), neurological complications (OR 2.4, 95% CI 1.5-3.7), and infectious complications (OR 2.7, 95% CI 1.8-4.3). NO-AKI patients' 5-year survival rate was higher than AKI patients (68.06, 95% CI 62.7-72.7 and 81.2, 95% CI 78.9-83.3, P<0.001).ConclusionsAKI still remains an important risk factor for morbidity and mortality after OLT. Further research to develop new strategies aimed at preventing or minimizing post-OLT AKI is needed.

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