Study Details AKI Prevalence, Risk Factors in Infant Liver Transplant Patients

Preoperative transfusion and decreased serum creatine levels are independently associated with acute kidney injury (AKI) in infant living-related liver transplant recipients with biliary atresia, according to findings from a retrospective study.

Among nearly 100 patients diagnosed with biliary atresia who received a living-related liver transplant, 60.2% experienced AKI within 7 days of surgery and experienced more frequent serious complications, longer hospital stays, and a greater duration of postoperative mechanical ventilation compared to patients who did not develop AKI.¹

“There is little research reporting the incidence and outcomes of AKI after living-related liver transplantation in infants. Most of the data from previous studies came from a wide age range of recipients and the different types of liver disease were analyzed together,” wrote investigators.¹

A rare disease causing liver damage, biliary atresia can be fatal without surgery and is the most common cause of liver transplantation in children in the US. AKI is a common complication of liver transplantation and is often associated with worse health outcomes in transplant patients, although little research thus far has focused on AKI after liver transplantation in infant patients.²

To assess the prevalence and impact of AKI on outcomes in infants with biliary atresia, Wei Liu, PhD, associate professor of human biology and technology at Chongqing University in China, and a team of investigators collected preoperative, intraoperative, and postoperative clinical data and laboratory test results for all infant patients who were diagnosed with biliary atresia and received living-related liver transplantation at the Children's Hospital of Chongqing Medical University between January 2018 and January 2021. Patients who received combined liver‐kidney transplantation, had previous AKI, chronic renal failure, multiple liver transplants, or lacked sufficient laboratory or clinical data were excluded from the study.¹

A total of 134 living-related liver transplants were performed during the study period, 36 of which were excluded due to patients not having a biliary atresia diagnosis (n = 22), receiving donation after circulatory death transplantation (n = 12), and being out of the infant age range (n = 2). The remaining 98 living-related liver transplant patients were enrolled in the study.¹

The primary outcome was the risk of postoperative AKI occurrence in the first 7 days postoperation, based on the serum creatine concentration measured daily and urine output measured every 2 hours. Secondary outcomes included the incidence of mild and severe complications, duration of mechanical ventilation, length of ICU and hospital stays, incidence of mortality, and renal function within 1 year after surgery. Investigators used a multivariate regression analysis model to determine risk factors for AKI and assess the incidence and impacts of AKI on outcomes.¹

Upon analysis, 59 (60.2%) participants developed AKI within 7 days of living-related liver transplantation. Stage 1 AKI, which was defined as an increase in serum creatinine 1.5– 1.9 times greater than baseline, an increase in serum creatine by ≥0.3 mg/dL, or a reduction in urine output to <0.5 mL/kg/h for 6–12 hours, was observed in 29 (29.6%) patients. Stage 2 AKI, which was defined as an increase in serum creatinine 2.0–2.9 times greater than baseline or a reduction in urine output to <0.5 mL/kg/h for ≥12 hours, was observed in 18 (18.4%) patients.¹

The remaining 12 (12.2%) patients were classified as having stage 3 AKI, defined as an increase in serum creatine to 3.0 times baseline, an increase in serum creatine to ≥4.0 mg/dL, a reduction in urine output to <0.3 mL/ kg/h for ≥24 hours, anuria for ≥12 hours, or initiation of kidney replacement therapy.¹

Multivariable logistic regression analysis revealed preoperative transfusion (P = .047; odds ratio [OR] = 0.318; 95% confidence interval [CI], 0.103–0.984) and lower preoperative serum creatine (P = .001; OR = 0.772; 95% CI, 0.660–0.903) were independently associated with AKI. Investigators noted the incidence of serious complications was greater in the AKI group (37.3%) compared to the non‐AKI group (18.0%; P = .045), but there was no significant difference in the incidence of mild complications (61.0% vs 48.7%, P = .299). The duration of postoperative mechanical ventilation (2 days vs 1 day; P = .046) and hospital stay (38 days vs 33 days; P = .013) in the AKI group were significantly longer than those in the non‐AKI group.¹

“In our next study, we will further extend the follow‐up period to observe the recovery of long‐term renal function in children with LRLT. Additionally, we will further compare the perioperative management and postoperative AKI of LRLT in children with BA and non-BA to better elucidate the perioperative anesthetic management of LRLT in different disease types,” concluded investigators.¹

References:

1. Liu W, Dai X, Guo H, You C, Du M, Li Q. Acute kidney injury after living‐related liver transplantation in infants with biliary atresia: a retrospective study. Pediatr Discov. 2023;e37. https://doi.org/10.1002/pdi3.37
2. Stanford Medicine Children’s Health. Biliary Atresia in Children. Accessed November 9, 2023. https://www.stanfordchildrens.org/en/topic/default?id=biliary-atresia-90-P01982