Background We aim to develop and validate a nomogram model for predicting severe acute kidney injury (AKI) after orthotopic liver transplantation (OLT). Methods A total of 576 patients who received OLT in our center were enrolled. They were assigned to the development and validation cohort according to the time of inclusion. Univariable and multivariable logistic regression using the forward variable selection routine were applied to find risk factors for post-OLT severe AKI. Based on the results of multivariable analysis, a nomogram was developed and validated. Patients were followed up to assess the long-term mortality and development of chronic kidney disease (CKD). Results Overall, 35.9% of patients were diagnosed with severe AKI. Multivariable logistic regression analysis revealed that recipients’ BMI (OR 1.10, 95% CI 1.04–1.17, p = 0.012), hypertension (OR 2.32, 95% CI 1.22–4.45, p = 0.010), preoperative serum creatine (sCr) (OR 0.96, 95% CI 0.95–0.97, p < 0.001), and intraoperative fresh frozen plasm (FFP) transfusion (OR for each 1000 ml increase 1.34, 95% CI 1.03–1.75, p = 0.031) were independent risk factors for post-OLT severe AKI. They were all incorporated into the nomogram. The area under the ROC curve (AUC) was 0.73 ( p < 0.05) and 0.81 ( p < 0.05) in the development and validation cohort. The calibration curve demonstrated the predicted probabilities of severe AKI agreed with the observed probabilities ( p > 0.05). Kaplan-Meier survival analysis showed that patients in the high-risk group stratified by the nomogram suffered significantly poorer long-term survival than the low-risk group (HR 1.92, p < 0.01). The cumulative risk of CKD was higher in the severe AKI group than no severe AKI group after competitive risk analysis (HR 1.48, p < 0.05). Conclusions With excellent predictive abilities, the nomogram may be a simple and reliable tool to identify patients at high risk for severe AKI and poor long-term prognosis after OLT.

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Primary systemic amyloidosis (PSA) is a systemic disease caused by amyloid deposition in various tissues and organs. In the early stages of the disease, approximately 40% of patients have skin damage, which may be the only clinical manifestation. This report described the case of a 67-year-old male with PSA who presented with characteristic cutaneous manifestations. Physical examination showed seborrheic keratotic-like plaques around the orbit, purpura and ecchymosis on the neck and dorsum manus, as well as nail dystrophy. An auxiliary examination indicated a 24-h urine protein content of 2.89 g, and serum immunoelectrophoresis showed a monoclonal λ light chain. Echocardiography showed decreased left ventricular diastolic function and mild pulmonary hypertension. The dermoscopic features were multiple comedo-like openings and milia-like cysts. Histopathology showed multiple keratinous cysts in the dermis and eosinophilic, acellular, homogenous material in the dermis that was Congo red-positive. The diagnosis was confirmed through biopsy of skin lesions and kidney.Skin lesions of this case are rare.Skin lesions around the orbit need to arouse the vigilance of dermatologists. PSA should be considered if the patient with multisystemic symptoms.Skin biopsy and Congo red staining were very important for early diagnosis of PSA.