Combining Acute Kidney Injury Grading and Recovery Mode for Screening in Pediatric Liver Transplantation: A Retrospective Observational Study

BACKGROUND: A growing number of studies indicate that acute kidney injury (AKI) and the pattern of recovery after kidney injury are associated with poor outcomes for grafts and long-term renal function after liver transplantation (LT). However, few systematic studies have been conducted on the pediatric liver transplantation (PLT) population. MATERIALS AND METHODS: In this single-centered retrospective observational study, according to AKI degree and whether AKI was persistent, patients were divided into three groups: non-AKI/stage 1 AKI, stage 2/3 transient AKI, and stage 2/3 persistent AKI. We compared the survival of patients, graft, and chronic kidney disease (CKD) among the three groups, analyzing the risk factors for the stage 2/3 persistent AKI. RESULTS: Among 700 patients, the total incidence of AKI was 39.57%; of children with stage 2/3 AKI, the condition was persistent in 38.06%. In the stage 2/3 persistent-AKI group, the risk of graft loss was 3.264× greater than in the no-AKI/stage 1 AKI group and 4.329× greater than in the stage 2/3 transient AKI group. Pediatric End-stage Liver Disease (PELD) score, preoperative estimated glomerular filtration rate (eGFR), duration of vena cava occlusion, postoperative respiratory support time, and postoperative early allograft dysfunction (EAD) were significantly correlated with the occurrence of stage 2/3 persistent AKI. CONCLUSIONS: By combining AKI recovery mode with AKI grading, clinicians can screen out stage 2/3 persistent AKI with a worse prognosis. This method was more accurate in predicting prognosis than applying AKI grading alone.