To explore the risk factors of acute kidney injury(AKI) after liver transplantation (LT).

Clinical data of 300 patients who underwent LT from January 2007 to August 2013 in Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed. The informed consents of all participating subjects were obtained and the local ethical committee approval had been received. According to whether the patients developed AKI after operation, the patients were divided into AKI group (n=93, 83 males and 10 females, age: 24-72 years old, median age of 48 years old) and non-AKI group (n=207, 183 males and 24 females, age: 20-75 years old, median age of 48 years old). The hospital mortality of two groups and mortality of patients with different stages in AKI group were observed. The differences of clinical parameters such as preoperative serum albumin (ALB), serum creatinine (Scr), glomerular filtration rate (GFR), model for end-stage liver disease with serum sodium (MELD-Na) score, intraoperative blood loss and transfusion, cold ischemia time, anhepatic period, duration of operation and development of sepsis after operation of two groups were compared. And the differences of clinical parameters of patients with different stages in AKI group were further compared. The comparison of normal distribution data was performed using t test and one-way analysis of variance. The comparison of non-normal distribution data was performed using rank sum test. The comparison of ratio was performed using Chi-square test.

The hospital mortality was 12% (11/93) in AKI group, and was 5% (10/207) in non-AKI group, where significant difference was observed (χ²=4.826, P<0.05). The mortality of patients in AKI group in risk stage, injury stage, failure stage were 3% (1/39), 15% (5/33), 33% (7/21) respectively with a gradual upward trend (χ²=10.806, P<0.05). The development of AKI was related with preoperative ALB, Scr, GFR, MELD-Na score, intraoperative blood loss and transfusion (t=-11.7, t=7.88, t=-4.37, Z=7.1, Z=10.0, t=3.89; P<0.05). The incidence of postoperative sepsis was 22% (20/93) in AKI group, and was 13% (27/207) in non-AKI group, where significant difference was observed (χ²=4.157, P<0.05). The development of acute kidney failure in AKI group was related with preoperative Scr, GFR, MELD-Na score, intraoperative blood loss and transfusion (F=18.31, F=7.03, H=22.49, H=6.58, H=8.68; P<0.05).

The mortality of patients with AKI after LT is high. The development of AKI after LT is related with preoperative ALB, renal function, MELD-Na score, intraoperative blood loss and transfusion. Perioperative monitoring should be enhanced to prevent AKI.