The AKI Prediction Score: a new prediction model for acute kidney injury after liver transplantation

Abstract

Background: Acute kidney injury (AKI) is a frequent complication after liver transplantation. Although numerous risk factors for AKI have been identified, their cumulative impact remains unclear. Our aim was therefore to design a new model to predict post-transplant AKI. Methods: Risk analysis was performed in patients undergoing liver transplantation in two centres (n = 1230). A model to predict severe AKI was calculated, based on weight of donor and recipient risk factors in a multivariable regression analysis according to the Framingham risk-scheme. Results: Overall, 34% developed severe AKI, including 18% requiring postoperative renal replacement therapy (RRT). Five factors were identified as strongest predictors: donor and recipient BMI, DCD grafts, FFP requirements, and recipient warm ischemia time, leading to a range of 0-25 score points with an AUC of 0.70. Three risk classes were identified: low, intermediate and high-risk. Severe AKI was less frequently observed if recipients with an intermediate or high-risk were treated with a renal-sparing immunosuppression regimen (29 vs. 45%; p = 0.007). Conclusion: The AKI Prediction Score is a new instrument to identify recipients at risk for severe posttransplant AKI. This score is readily available at end of the transplant procedure, as a tool to timely decide on the use of kidney-sparing immunosuppression and early RRT.

Prognostic nutritional index predicts acute kidney injury and mortality of patients in the coronary care unit

“…These findings were then further validated in the hospital cohort. Moreover, in the current study, the AUCs of PNI for AKI were 0.755 in the test cohort and 0.738 in the validation cohort, which were consistent with previous models for AKI in different populations (38,39).…”

Association of overweight with postoperative acute kidney injury among patients receiving orthotopic liver transplantation: an observational cohort study

“…A previous study suggested that patients with BMI > 25 should get more attention even in patients with normal preoperative renal function [30]. Another study included recipient BMI as a predictor in their prediction model for AKI after liver transplantation [31]. In the study of Hilmi, weight > 100 kg was associated with the development of AKI within 72 h [5].…”

Early Acute Kidney Injury Associated with Liver Transplantation: A Retrospective Case-Control Study

“…The present study also investigated whether infusion of FFP is involved in the AKI. Kalisvaart et al found that FFP requirement during LT was the best predictor of post-transplant AKI [ 26 ]. In this study, FFP requirement was independently associated with AKI, which is consistent with previous research.…”