- Design
- Systematic review and meta-analysis of retrospective cohort studies
- Population
- 17 studies, 2,986 paediatric liver transplant recipients
- Primary outcome
- Incidence and risk factors of post-transplant AKI
- Effect
- Pooled AKI incidence 30.7% (95% CI 25.0–36.3%)
This systematic review pooled 17 retrospective cohort studies of 2,986 children undergoing liver transplantation. The pooled incidence of acute kidney injury was 30.7% (95% CI 25.0% to 36.3%).
Factors associated with AKI included pre-transplant liver dysfunction, coagulation abnormalities, poor nutrition, intraoperative blood loss, transfusion burden, ischaemia-reperfusion injury and the need for continuous organ support after surgery. Many factors were examined in only a few studies, and the authors caution against over-interpreting individual estimates.
For nephrologists consulted on these children, the main message is the high baseline rate: AKI is common enough to warrant planned kidney-protective care from the start, including careful fluid balance, avoidance of nephrotoxins and attention to calcineurin inhibitor levels.
- Expect AKI in about 1 in 3 children after liver transplantation.
- Plan kidney-protective care before surgery in high-risk children.
- Monitor creatinine and urine output closely in the first postoperative days.
- Keep calcineurin inhibitor levels in range and avoid other nephrotoxins where possible.
Why it matters
The high rate makes early nephrology involvement worth planning, not reacting to.
Don't overread it
Observational (retrospective cohorts); the risk factors are associations, not causes.
The statistics, in plain English
All included studies were retrospective, so risk factors are associations. AKI definitions varied between studies, which affects the pooled incidence.
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