ORIGINAL RESEARCH article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Perioperative Hemoglobin Concentrations are associated with Acute Kidney Injury after Deceased Donor Liver Transplantation
Paul Lichtenegger 1
Alexandra Graf 2,1
Judith Schiefer 1
Aylin Bilir 1
Dagmar Kollmann 1
Gabriela Berlakovich 1
Peter Faybik 1
David M. Baron 1
Joanna Baron-Stefaniak 1
1. Medizinische Universitat Wien, Vienna, Austria
2. Medical University of Vienna, Vienna, Austria
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Abstract
Background: Acute kidney injury (AKI) is common after orthotopic liver transplantation (OLT). In major surgery, anemia has been associated with postoperative AKI. Although patients undergoing OLT frequently suffer from anemia, its impact on postoperative AKI remains unclear. We performed a single-center retrospective study including 724 patients undergoing their first OLT between January 2004 and December 2019 at the Medical University of Vienna. We evaluated whether perioperative hemoglobin concentrations were associated with postoperative AKI, renal replacement therapy, or mortality. Preoperative hemoglobin concentrations were 10.9 (±2.1) g/dl in patients with AKI after OLT and 11.5 (±2.1) g/dl in those without. Higher preoperative hemoglobin concentrations were associated with a lower probability of AKI (OR 0.847; P<0.001) and a decreased probability of developing a higher AKI stage (OR: 0.895; P=0.002). Stage 3 AKI was associated with increased one-year (OR:1.909; P<0.001) and overall mortality (HR: 1.420; P=0.037). Higher nadir hemoglobin concentrations within 48 hours after OLT were associated with a lower probability of AKI (OR: 0.806; P=0.033) and a decreased probability of developing a higher AKI stage (OR: 0.782; P<0.001). In conclusion, higher perioperative hemoglobin concentrations were associated with a lower probability of AKI after OLT. Severe AKI was associated with an increased mortality.
Summary
Keywords
Anemia, Dialysis, Kidney failure, Morbidity, Orthotopic liver transplantation, renal failure, Renal Replacement Therapy, Survival
Received
20 August 2025
Accepted
27 January 2026
Copyright
© 2026 Lichtenegger, Graf, Schiefer, Bilir, Kollmann, Berlakovich, Faybik, Baron and Baron-Stefaniak. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Alexandra Graf
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