ORIGINAL RESEARCH article
Front. Physiol.
Sec. Renal Physiology and Pathophysiology
Volume 16 - 2025 | doi: 10.3389/fphys.2025.1614336
Identification of the risk factors for predicting severe acute kidney injury in patients after liver transplantation
Provisionally accepted
- 1Beijing Chaoyang Hospital, Capital Medical University, Beijing, Beijing Municipality, China
- 2West China Fourth Hospital of Sichuan University, Chengdu, Sichuan Province, China
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Background: Acute kidney injury(AKI) is one of the most common complications after liver transplantion (LT). Few studies have fucosed on the risk factors for the severe AKI (KDIGO criteria: stage 3) after LT. This study aimed to identify critical determinants associated with progression to severe AKI in LT patients admitted to the intensive care unit (ICU).: This retrospective case control study analyzed data from the Medical Information Mart for Intensive Care -IV datasets version 3.1 (MIMIC-IV). Patients were divided into 2 groups acording to the stage of AKI. Patients diagnosed as AKI stage I or II were in mild-AKI Group, and the others diagnosed as AKI stage Ⅲ were in severe-AKI Group. Risk factors was figured out after the univariate and multivariable logistic regression models between groups. Restricted cubic splines (RCS) was conducted to determine threshold effects of the identified risk factors on severe AKI .Results: A total of 251 patients were enrolled. 131 patients were classified as AKI stage I or II (Mild AKI Group), while 120 patients were diagnosed with AKI stage Ⅲ (Severe AKI Group). Multivariable logistic regression analysis revealed that gender (female), total bilirubin, serum creatinine, and Simplified Acute Physiology Score II (SAPS II) were independent risk factors for severe AKI in LT patients. Male patients had a significantly lower risk of severe AKI compared to females (p = 0.023; OR = 0.349; 95% CI: 0.138-0.854). RCS analysis further revealed nonlinear associations with critical inflection points at total bilirubin 12.189 mg/dL, serum creatinine 1.118 mg/dL, and SAPS-II of 42. Beyond these thresholds, each incremental increase in these parameters demonstrated a statistically significant escalation in severe AKI risk.In our study, we found that gender(female), total bilirubin (≥ 12.189 mg/dL), creatinine (≥ 1.118 mg/dL), and SAPS-II (≥ 42) are the independent risk factors for severe AKI in patients after LT.
Keywords: Liver Transplantation, Acute Kidney Injury, risk factor, restricted cubic splines, SAPS-II
Received: 18 Apr 2025; Accepted: 23 Jun 2025.
Copyright: © 2025 Yang, WANG, ZHOU and HAN. 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: LIN HAN, West China Fourth Hospital of Sichuan University, Chengdu, Sichuan Province, China
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