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

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.

Promises of Big Data and Artificial Intelligence in Nephrology and Transplantation

“…Those needs that are classified as unmet require provision of some ample spaces for the purpose of imagination in relation to leveraging the strength associated with big data, as well as relevant artificial intelligence (AI) to improve the overall status of patients with kidney diseases [25]. In this article, we discuss the big data concepts in nephrology, describe the potential use of AI in nephrology and transplantation, and also encourage researchers and clinicians to submit their invaluable research, including original clinical research studies [26][27][28][29][30], database studies from registries [31][32][33], meta-analyses [34][35][36][37][38][39][40][41][42][43][44], and artificial intelligence research [25,[45][46][47][48] in nephrology and transplantation. Table 1 demonstrates known and commonly used databases that have provided big data in nephrology and transplantation [49][50][51].…”

Novel Biomarkers in Patients with Chronic Kidney Disease: An Analysis of Patients Enrolled in the GCKD-Study

“…In patients with chronic kidney disease (CKD), a high burden of cardiovascular diseases (CVD) is common, and an inverse correlation of renal function with the prevalence of coronary artery disease, congestive heart failure, and cerebrovascular disease is observed [1,50]. Moreover, the incidence of acute kidney injury has been steadily increasing in recent years, leading to higher healthcare costs and mortality and contributing to increasing prevalence rates of CKD [51,52]. With an increasing prevalence of CKD from variable causes, the number of patients with end-stage renal disease is on the rise [1,53].…”

Acute kidney disease stage predicts outcome of patients on extracorporeal membrane oxygenation support

“…The global burden of AKI is around 13.3 million cases per year with hospitalizations for AKI rising over time. A published meta-analysis showed that in the United States alone, AKI is associated with 1 hospitalization every 7.5 minutes [8]. A single-center study reported that the in-hospital mortality rate and 6-month survival rate of patients treated with ECMO who had concomitant AKI were worse than those of patients who did not develop AKI [6].…”