Acute kidney injury after pediatric liver transplantation: incidence, risk factors, and association with outcome

Purpose: Data on the incidence of, risk factors for, and association with outcomes of acute kidney injury (AKI) after pediatric liver transplantation are scarce. We conducted a retrospective cohort study to determine the incidence of AKI after pediatric liver transplantation. In addition, we examined risk factors for AKI and association of AKI with outcomes.

Methods: This study included 156 children aged between 3 months and 18 years undergoing liver transplantation at Kyoto University Hospital. AKI was defined according to the Kidney Disease: Improving Global Outcomes guidelines based on serum creatinine and urine output. We used multivariable logistic regression with stepwise variable selection to identify independent risk factors for AKI.

Results: AKI occurred in 72 patients (46.2%); 34 (21.8%) had stage 1, 32 (20.5%) had stage 2, and 6 (3.8%) had stage 3 AKI. Factors independently associated with the development of AKI were increased preoperative total bilirubin level (adjusted odds ratio, 1.04 per 1 mg/dl; 95% confidence interval, 1.01-1.09; P = 0.026) and increased intraoperative blood loss (adjusted odds ratio, 1.03 per 10 ml/kg; 95% confidence interval, 1.00-1.06; P = 0.022). AKI was significantly associated with prolonged hospitalization (median, 61 vs. 46 days; P = 0.028). In-hospital mortality rate was 4.2% in patients with AKI and 3.6% in those without AKI (P = 1.000).

Conclusion: The incidence of AKI after pediatric liver transplantation was 46.2%. Increased preoperative total bilirubin level and increased intraoperative blood loss were independently associated with the development of AKI. AKI was associated with prolonged hospitalization.