Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Mar 17;8(3):372.
doi: 10.3390/jcm8030372.

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

Charat Thongprayoon  1 , Wisit Kaewput  2 , Natanong Thamcharoen  3 , Tarun Bathini  4 , Kanramon Watthanasuntorn  5 , Ploypin Lertjitbanjong  6 , Konika Sharma  7 , Sohail Abdul Salim  8 , Patompong Ungprasert  9 , Karn Wijarnpreecha  10 , Paul T Kröner  11 , Narothama Reddy Aeddula  12 , Michael A Mao  13 , Wisit Cheungpasitporn  14
Affiliations

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

Charat Thongprayoon et al. J Clin Med. .

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.

Keywords: Acute kidney injury; Acute renal failure; Epidemiology; Incidence; Liver Transplantation; Meta-analysis; Systematic reviews; Transplantation.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Outline of our search methodology.
Figure 2
Figure 2
Forest plots of the included studies assessing incidence rates of post-LTx AKI. A diamond data marker represents the overall rate from each included study (square data marker) and 95% confidence interval.
Figure 3
Figure 3
Forest plots of the included studies assessing incidence rates of severe AKI requiring RRT following LTx. A diamond data marker represents the overall rate from each included study (square data marker) and 95% confidence interval.
Figure 4
Figure 4
Meta-regression analyses showed no significant impact of year of study on the incidence of post-LTx AKI (p = 0.81). The solid black line represents the weighted regression line based on variance-weighted least squares. The inner and outer lines show the 95% confidence interval and prediction interval around the regression line. The circles indicate log event rates in each study.
Figure 5
Figure 5
Forest plots of the included studies assessing liver graft failure among patients with post-LTx AKI. A diamond data marker represents the overall rate from each included study (square data marker) and 95% confidence interval.
Figure 6
Figure 6
Forest plots of the included studies assessing CKD risk among patients with post-LTx AKI. A diamond data marker represents the overall rate from each included study (square data marker) and 95% confidence interval.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Gameiro J., Agapito Fonseca J., Jorge S., Lopes J.A. Acute Kidney Injury Definition and Diagnosis: A Narrative Review. J. Clin. Med. 2018;7:307. doi: 10.3390/jcm7100307. - DOI - PMC - PubMed
    1. Hoste E.A.J., Kellum J.A., Selby N.M., Zarbock A., Palevsky P.M., Bagshaw S.M., Goldstein S.L., Cerdá J., Chawla L.S. Global epidemiology and outcomes of acute kidney injury. Nat. Rev. Nephrol. 2018;14:607–625. doi: 10.1038/s41581-018-0052-0. - DOI - PubMed
    1. Mehta R.L., Burdmann E.A., Cerdá J., Feehally J., Finkelstein F., García-García G., Godin M., Jha V., Lameire N.H., Levin N.W., et al. Recognition and management of acute kidney injury in the International Society of Nephrology 0by25 Global Snapshot: A multinational cross-sectional study. Lancet. 2016;387:2017–2025. doi: 10.1016/S0140-6736(16)30240-9. - DOI - PubMed
    1. Mehta R.L., Burdmann E.A., Cerdá J., Feehally J., Finkelstein F., García-García G., Godin M., Jha V., Lameire N.H., Levin N.W., et al. International Society of Nephrology’s 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): A human rights case for nephrology. Lancet. 2015;385:2616–2643. doi: 10.1016/S0140-6736(15)60126-X. - DOI - PubMed
    1. Sawhney S., Marks A., Fluck N., Levin A., McLernon D., Prescott G., Black C. Post-discharge kidney function is associated with subsequent ten-year renal progression risk among survivors of acute kidney injury. Kidney Int. 2017;92:440–452. doi: 10.1016/j.kint.2017.02.019. - DOI - PMC - PubMed

LinkOut - more resources