Meta-analysis Of Risk Factors For Early Acute Kidney Injury After Liver Transplantation

Objective:Liver transplantation has become the most effective treatment for end-stage liver disease.Early postoperative acute kidney injury is a common clinical complication.The aim of this study was to investigate the risk factors associated with acute kidney injury after liver transplantation in order to deepen the understanding of this serious clinical complication and to guide clinical practice.Methods:In this study,we searched the published literatures on acute kidney injury after liver transplantation in databases such as CNKI,CBM,VIP,Wanfang,PubMed,EMBASE,and Cochrane Library.RevMan 5.3 software was used to analyze the relevant risk factors involved in these literatures.The data from multiple centers were combined using a meta-analysis method to obtain a more reliable estimation of risk factors for this complication.Results:After strict screening,a total of 25 studies were included.There were 1824 in case group(AKI group)and 4349 in control group(Non-AKI group)respectively.A meta-analysis of 13 risk factors suggested that: there were no significant differences in cold ischemia time and venous-venous bypass between the two groups.(p>0.05).The BMI(p=0.01)and the preoperative MELD score(p<0.00001)were higher in the case group than in the control group;the preoperative serum albumin level(p<0.00001)and hemoglobin level(p=0.02)were low in the case group.The WIT of the case group were longer than those in the control group(p=0.008);the volume of packed red blood cells and fresh frozen plasma using in the case group was more than that in the control group(p<0.00001);patients with NAFLD were more likely to have AKI after postoperatively(p=0.03),[OR 1.71(1.04,2.8)];patients undertaking liver transplantation because of primary liver cancer had a lower likelihood of postoperative AKI than patients with benign end-stage liver disease(p=0.009),[OR-0.07(-0.13,-0.02)];using donation after cardiac death was more likely to have AKI(p=0.03),[OR 1.39(1.03,1.88)];using piggyback technique in liver transplantation may reduce the occurrence of postoperative AKI(p=0.001),[OR 1.81(1.26,2.60)];using vasopressors during the surgery increase the chance of postoperative AKI(p<0.00001),[OR 4.07(2.63,6.31)] Conclusion:BMI,preoperative MELD score,NAFLD,primary liver cancer,preoperative serum albumin,hemoglobin,donor type of DCD,warm ischemia time,using piggyback technique,intraoperative blood product transfusion,using vasopressors are factors affecting the risk of AKI after liver transplantation;AKI after LT have no relationship with cold ischemia time,intraoperative VVB use.