Acute Kidney Injury following Liver Transplantation: A Systematic Review of Published Predictive Models

Abstract

Acute kidney injury (AKI) is a frequent postoperative complication amongst liver transplant recipients and is associated with increased morbidity and mortality. This systematic review analysed the existing predictive models, in order to solidify current understanding. Articles were selected for inclusion if they described the primary development of a clinical prediction model (either an algorithm or risk score) to predict AKI post liver transplantation. The database search yielded a total of seven studies describing the primary development of a prediction model or risk score for the development of AKI following liver transplantation. The models span thirteen years of clinical research and highlight a gradual change in the definitions of AKI, emphasising the need to employ standardised definitions for subsequent studies. Collectively, the models identify a diverse range of predictive factors with several common trends. They emphasise the impact of preoperative renal dysfunction, liver disease severity and aetiology, metabolic risk factors as well as intraoperative variables including measures of haemodynamic instability and graft quality. Although several of the models address postoperative parameters, their utility in predictive modelling seems to be of questionable relevance. The common risk factors identified within this systematic review provide a minimum list of variables, which future studies should address. Research in this area would benefit from prospective, multisite studies with larger cohorts as well as the subsequent internal and external validation of predictive models. Ultimately, the ability to identify patients at high risk of post-transplant AKI may enable early intervention and perhaps prevention.

Evaluation of Perioperative Predictors of Acute Kidney Injury Post Orthotopic Liver Transplantation

“…The definition of AKI itself is also not standardised in the literature, which adds further complexity to this subject. Additionally, commonly used surrogates of renal function may have reduced accuracy in end-stage liver disease; serum creatinine levels can be misleadingly low and blood urea nitrogen levels can be artificially low or high 6 .…”

“…The aforementioned difficulties in measuring and defining renal dysfunction make comparison of separate studies more Correspondence complicated. In fact, several authors of predictive models for AKI post LT have not included any surrogate for preoperative renal dysfunction, as is highlighted in the recent literature review by Caragata et al 6 . Furthermore, multiple studies have shown that post LT renal impairment also occurs frequently in patients with normal baseline renal function 6 .…”

Temporal trends of dialysis requiring acute kidney injury after orthotopic cardiac and liver transplant hospitalizations

“…There are several (mostly single center) studies outlining frequency, risk factors or outcomes of AKI in immediate post-transplant period [10, 15]. However, there are limited data on the epidemiology of trends in AKI over time, particularly severe AKI requiring dialysis (AKI-D), in all hospitalizations among orthotopic cardiac and liver transplant recipients.…”

New trends in the study of post-transplant acute kidney injury after liver transplantation

“…Использование стандартных классификаций для диагностики и стратификации ОПП способствовало повышению выявляемости данного синдрома в клинической практике и эпидемиологических исследованиях [5]. R. Caragata et al [51] указывают на постепенные изменения в понятии ОПП и подчеркивают необходимость использования стандартизированного определения в последующих исследованиях. Классификации ОПП по критериям AKIN, RIFLE и KDIGO позволяют оценить тяжесть дисфункции почек у пациентов после ТП [52].…”