Outcomes of Acute Kidney Injury After Pediatric Liver Transplantation: A 1-Year Follow-Up

IF 1.9 4区医学 Q2 SURGERY Clinical Transplantation Pub Date : 2024-12-28 DOI:10.1111/ctr.70063

Jiemei Ji, Shengfeng Liang, Jian Lai, Zhongxuan Mao, Yunan Lin, Yuyan Lan, Jingchen Liu

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Abstract

Background

Postoperative acute kidney injury (AKI) and chronic kidney disease (CKD) following pediatric liver transplantation (PLT) have not been comprehensively studied. This study aimed to evaluate the correlation between AKI and both 1-year CKD and mortality.

Methods

This retrospective study included 132 children aged between 3 months and 12 years who underwent PLT between 2017 and 2021. Postoperative AKI and CKD after 1 year were assessed according to KDIGO criteria. AKI was classified as mild, moderate, or severe based on severity as well as transient (≤2 days) and persistent (>2 days) based on duration. CKD occurrence was the primary outcome, whereas all-cause mortality was the secondary outcome.

Results

AKI developed in 45.4% of children, with 40.7% mild, 37.1% moderate, and 22.2% severe. Half of the children with AKI subsequently developed CKD within 1 year, compared to 23.1% without AKI. Multivariate analysis indicated that moderate AKI, severe AKI, and persistent AKI were risk factors for CKD development (moderate AKI, OR = 3.8, 95% CI = 1.2–12.3; severe AKI, OR = 7.4, 95% CI = 1.4–38.3; persistent AKI, OR = 9.7, 95% CI = 2.3–36.4). The overall mortality rate within 1 year after surgery was 9.8%. Children with severe AKI and AKI lasting longer than 2 days exhibited a higher mortality rate than those without AKI.

Conclusions

The development of postoperative AKI is relatively common after PLT, and the severity and duration of AKI are associated with CKD and mortality within 1 year.

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儿童肝移植后急性肾损伤的结果：1年随访。

背景：儿童肝移植（PLT）术后急性肾损伤（AKI）和慢性肾脏疾病（CKD）的研究尚未全面。本研究旨在评估AKI与1年CKD和死亡率之间的相关性。方法：本回顾性研究纳入了2017年至2021年期间接受PLT治疗的132名3个月至12岁儿童。根据KDIGO标准评估术后1年AKI和CKD。AKI根据严重程度分为轻度、中度或重度，根据持续时间分为短暂性（≤2天）和持续性（>2天）。CKD的发生是主要结局，而全因死亡率是次要结局。结果：45.4%的儿童发生AKI，其中轻度40.7%，中度37.1%，重度22.2%。有一半患有AKI的儿童随后在1年内发展为CKD，而没有AKI的儿童则为23.1%。多因素分析表明，中度AKI、重度AKI和持续性AKI是CKD发展的危险因素(中度AKI， OR = 3.8, 95% CI = 1.2-12.3；重度AKI， OR = 7.4, 95% CI = 1.4-38.3；持续性AKI， OR = 9.7, 95% CI = 2.3-36.4)。术后1年内总死亡率为9.8%。重度AKI和AKI持续时间超过2天的儿童的死亡率高于无AKI的儿童。结论：PLT术后AKI的发生较为常见，AKI的严重程度和持续时间与CKD和1年内死亡率相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.