Hypoalbuminemia Within Two Postoperative Days Is an Independent Risk Factor for Acute Kidney Injury Following Living Donor Liver Transplantation: A Propensity Score Analysis of 998 Consecutive Patients*

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Abstract

Objective:

Acute kidney injury is a known major complication of liver transplantation. Previous reports have shown that hypoalbuminemia is associated with an increased risk of acute kidney injury. However, little is known about the relationship between the early postoperative albumin level and acute kidney injury after living donor liver transplantation. The aim of this study was to identify the influence of the postoperative albumin level on acute kidney injury prevalence after living donor liver transplantation.

Design:

A retrospective analysis.

Setting:

A tertiary care university hospital.

Patients:

Nine hundred and ninety-eighty patients underwent living donor liver transplantation.

Interventions:

None.

Measurements and Main Results:

We divided the enrolled patients into two groups: group 1 included patients whose postoperative albumin level was less than 3.0 g/dL (n = 522), and group 2 included patients with an albumin level greater than or equal to 3.0 g/dL (n = 476). The prevalence of acute kidney injury, major adverse cardiac events, hospital stay, ICU stay, 30-day mortality, and overall mortality was analyzed using inverse probability of treatment weighting and propensity-score matching (n = 249 pairs) analysis. The prevalence of acute kidney injury was higher in group 1 defined by both Acute Kidney Injury Network (after adjusting for inverse probability of treatment weighting [n = 364; 69.7%] and propensity-score matching [n = 152; 61.0%]) and Risk, Injury, Failure, Loss, and End-stage kidney disease criteria (after adjusting for inverse probability of treatment weighting [n = 419; 80.3%] and propensity-score matching [n = 190; 76.3%]). The overall mortality was higher in group 1 after adjusting for inverse probability of treatment weighting (n = 61; 11.7%) and propensity-score matching (n = 23; 9.2%). The hospital (p < 0.001) and ICU (p = 0.006) stays were significantly prolonged in group 1. Acute kidney injury was associated with ICU stay by the Acute Kidney Injury Network criteria (p = 0.034), and overall mortality was correlated with acute kidney injury by the Risk, Injury, Failure, Loss, and End-stage kidney disease criteria (p = 0.014).

Conclusions:

Early postoperative hypoalbuminemia is an independent risk factor for acute kidney injury, and postoperative acute kidney injury is related to postoperative ICU stay and overall mortality after living donor liver transplantation.

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