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Meta-Analysis
. 2021 Apr 23;22(1):149.
doi: 10.1186/s12882-021-02360-8.

Modifiable risk factors of acute kidney injury after liver transplantation: a systematic review and meta-analysis

Jian Zhou  1 , Xueying Zhang  2 , Lin Lyu  1 , Xiaojun Ma  1 , Guishen Miao  1 , Haichen Chu  3
Affiliations
Meta-Analysis

Modifiable risk factors of acute kidney injury after liver transplantation: a systematic review and meta-analysis

Jian Zhou et al. BMC Nephrol. .

Abstract

Background: Acute kidney injury (AKI) is a common and critical complication of liver transplantation (LT), which is associated with increased morbidity, mortality and health care cost. We aimed to identify modifiable risk factors of AKI after LT.

Methods: A literature search of Pubmed, EMBASE and Cochrane Databases was performed to identify studies investigating risk factors of AKI after LT. The Newcastle-Ottawa Scale was used to rate study quality. Effect size and 95% confidence interval were pooled using a random-effect model with inverse-variance method.

Results: Sixty-seven articles with 28,844 patients were included in the meta-analysis. Seventeen modifiable risk factors were found, including overweight, preoperative use of diuretic, preoperative anemia, donation after cardiac death organ, donor BMI ≥ 30 kg/m2, ABO-incompatible LT, low graft to recipient body weight ratio, intraoperative hypotension, major bleeding, intraoperative use of vasopressor, large RBC transfusion, postreperfusion syndrome, postoperative use of vasopressors, overexposure to calcineurin inhibitor, calcineurin inhibitor without mycophenolate mofetil, graft dysfunction and infection. A total of 38 articles were included in the systematic review, in which 8 modifiable risk factors and 1 protective factor were additionally associated in single studies with the incidence of AKI after LT.

Conclusions: Effective interventions based on identified modifiable risk factors in the perioperative management and graft allocation and preservation may be promising to reduce the incidence of AKI after LT.

Trial registration: The protocol for this systematic review is registered with PROSPERO (No. CRD42020166918 ).

Keywords: Acute kidney injury; Liver transplantation; Meta-analysis; Modifiable risk factors.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram
Fig. 2
Fig. 2
Forest plots of the included studies assessing incidence rates of AKI after LT. A diamond data marker represents the overall rate from each included study (square data marker) and 95% confidence interval
Fig. 3
Fig. 3
Meta-regression of incidence rate of AKI after LT on publication year
Fig. 4
Fig. 4
Modifiable factors that show significant association with AKI after LT in the meta-analysis. OR, odds ratio; CI, confidence interval; DCD, donation after cardiac death; BMI, body mass index; GW/RBW, graft weight to recipient body weight ratio; RBC, red blood cell; CNI: calcineurin inhibitor; MMF: mycophenolate mofetil
Fig. 5
Fig. 5
Modifiable factors that show significant association with AKI after LT in the systematic review. OR, odds ratio; CI, confidence interval
Fig. 6
Fig. 6
Identified modifiable factors of AKI after LT. OR, odds ratio; DCD, donation after cardiac death; BMI, body mass index; GW/RBW, graft weight to recipient body weight ratio; RBC, red blood cell; CNI: calcineurin inhibitor; MMF: mycophenolate mofetil; LT, liver transplantation; PH, pulmonary hypertension
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