Prevalence of acute kidney injury after liver transplantation in children: Comparison of the pRIFLE, AKIN, and KDIGO criteria using corrected serum creatinine

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Purpose:To compare the application of three standardized definitions of acute kidney injury (AKI), using corrected serum creatinine values, in children immediately after liver transplantation.Methods:Retrospective search of a tertiary pediatric hospital database yielded 77 patients (age<18years) who underwent liver transplantation in 2007–2017. Serum creatinine levels during the 24h before and after surgery were corrected to daily fluid balance, and the prevalence of AKI was calculated using the Pediatric RIFLE (pRIFLE), AKI Network (AKIN), and Kidney Disease Improving Global Outcomes (KDIGO) criteria.Results:AKI occurred in 44 children (57%) according to the pRIFLE criteria (stage I, 34%; stage II, 10%, stage III, 13%) and 33 children (43%) according to the AKIN and KDIGO criteria (stage I, 20%; stage II, 10%; stage III, 13%). There was a good correlation (kappa=0.78) among the three criteria. AKI was associated with longer duration of mechanical ventilation (5.5±6.2 vs 3.6±4.0days, p<.05) and longer ICU stay (15.2±8.8 vs 12.1±7.5days, p<.05). Serum creatinine normalized in all patients (mean, 0.43±0.17mg/dl) by one year.Conclusions:There is a good correlation among the three criteria defining AKI in pediatric liver transplant recipients. AKI is highly prevalent in this patient group and confers a worse ICU course.HIGHLIGHTSAKI is common among pediatric LTx patients and ranges from 43% to 57%, depends on the classification criteria used.There is a good correlation between KDIGO, pRIFLE and AKIN criteria when defining AKI among pediatric LTx patients.Children with AKI had more days on mechanical ventilation and longer length of ICU stay compared to children without LTx children had, adjusted for age, normal creatinine values, within the year post transplantation.

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