Can Intraoperative Anesthesiological Management Reduce the Risk of Acute Kidney Injury After Liver Transplantation? A...

Area of Science:

• Nephrology
• Transplantation Surgery
• Anesthesiology

Background:

• Acute kidney injury (AKI) is a significant complication post-liver transplantation (LT), impacting mortality and long-term kidney health.
• Intraoperative anesthetic management presents modifiable factors crucial for AKI prevention in LT recipients.

Purpose of the Study:

• To systematically review AKI prevalence after LT.
• To examine the link between intraoperative anesthetic management and post-LT AKI.
• To identify modifiable factors for improved perioperative strategies.

Main Methods:

• Systematic search of PubMed, EMBASE, Cochrane Library, and Scopus (2004-2025).
• Inclusion of randomized controlled trials and cohort studies on intraoperative AKI predictors.
• Primary outcome: incidence of post-LT AKI; secondary: intraoperative factors (hemodynamics, fluids, transfusions, vasopressors).

Main Results:

• Pooled incidence of post-LT AKI was 41% (95% CI 36-46%) in observational studies.
• Intraoperative hemodynamic instability, fluid management issues, liberal transfusions, and suboptimal vasopressor use were linked to higher AKI risk.
• 50 studies (8 RCTs, 42 cohort) involving 22,434 patients were analyzed.

Conclusions:

• Post-liver transplant AKI is largely influenced by modifiable perioperative factors.
• Key preventive strategies include stable hemodynamics, judicious fluid and transfusion management, and avoiding hypotension.
• Personalized, kidney-protective approaches are vital for enhancing post-transplant outcomes, with prompt vasopressor support showing protective effects.