Incidence and Risk Factors for Progression of Acute Kidney Injury to Chronic Kidney Disease After Liver Transplantation: A Retrospective Cohort Study

Abstract

Acute kidney injury (AKI) following liver transplantation has the potential to progress to chronic kidney disease (CKD), which can result in extended hospital stays, elevated healthcare costs, and increased mortality rates. This retrospective cohort study seeks to examine the prognosis of AKI progression to CKD post-liver transplantation and to identify its independent risk factors. A cohort of 443 patients who developed AKI post-liver transplantation was analyzed, with participants categorized into a CKD group and a non-CKD group. The progression of AKI to CKD was observed in 29.3% (130 out of 443) of cases. Patients who developed CKD exhibited a significantly higher 1-year mortality rate of 4.6% (p = 0.004). Multivariate logistic regression analysis identified several independent risk factors for the progression from AKI to CKD, including preoperative diabetes (odds ratio [OR] 2.62; 95% confidence interval [CI] 1.32, 5.21), hepatic malignancy (OR 1.95; 95% CI 1.06, 3.57), elevated preoperative serum creatinine (SCr) levels (OR 1.02; 95% CI 1.01, 1.03), transition from postoperative AKI to acute kidney disease (AKD) (OR 3.99; 95% CI 1.94, 8.23), AKD stages 2 and 3 (OR 2.48; 95% CI 1.33, 4.61), and an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m² within 30 days (OR 3.03; 95% CI 1.70, 5.40). Conversely, higher preoperative hematocrit (HCT) levels (OR 0.00; 95% CI 0.00, 0.26) and recovery from AKD (OR 0.49; 95% CI 0.27, 0.86) were associated with a reduced risk of progression from postoperative AKI to CKD. The progression of AKI to CKD following liver transplantation is independently associated with preoperative diabetes, hepatic malignancy, elevated preoperative SCr levels, postoperative transition from AKI to AKD, AKD stages 2 and 3, and an eGFR of less than 60 mL/min/1.73 m² within 30 days.

Keywords: acute kidney injury; chronic kidney disease; incidence; independent risk factor; liver transplantation; surgery.

FIGURE 1

Enrollment flow chart for the present study.

FIGURE 2

Survival analysis of the non‐CKD group and CKD group. (A) Depicts readmission—free survival over 12 months, with CKD group having lower probability (p < 0.0001); (B) shows survival probability, where CKD group has lower probability (p = 0.00092), both illustrating CKD impacts on post—surgery outcomes within 1 year.