Risk Factors for Acute Kidney Injury After Conventional Open Liver Transplantation: A Single-Center Retrospective Cohort Study.

Background

Acute kidney injury (AKI) is frequent after liver transplantation (LT). We evaluated its incidence, risk factors, and survival impact.

Methods

We retrospectively analyzed 341 adult recipients who underwent conventional open LT between January 2019 and January 2024. Patients undergoing nonstandard implantation techniques, laparoscopic-assisted LT, combined liver-kidney transplantation, or retransplantation, as well as those with pretransplant eGFR <30 mL/min/1.73 m2 or incomplete data, were excluded.

Results

AKI occurred in 54.3% (stage 1, 39.6%; stage 2, 9.4%; stage 3, 5.3%). The modified piggyback technique was associated with a lower incidence of AKI than classical caval replacement (47.1% vs 61.5%, P = .01). Multivariable analysis identified surgical technique, donor ICU stay, donor weight, operative time, and cumulative duration of MAP <65 mm Hg as independent factors associated with AKI. One-year survival was lower in the AKI group (82.4% vs 93.3%; P = .003).

Conclusions

Post-LT AKI was common and associated with increased 1-year mortality. Surgical technique, donor ICU stay, donor weight, operative time, and intraoperative hypotension were independently associated with AKI risk. These findings highlight potentially modifiable perioperative factors relevant to post-LT AKI risk.