Table 1 Meta-analysis of risk factors for acute kidney injury after liver transplantation
Factor | type | No. of study | Sample | Pooled OR (95% CI) | Heterogeneity | P value | |
|---|---|---|---|---|---|---|---|
I2 | Chi2 | ||||||
Recipient factors | |||||||
 Age (per year) | C | 11 | 5476 | 1.006 (0.998–1.015) | 78.3 | 0.000 | 0.155 |
 Older age | B | 3 | 380 | 0.956 (0.536–1.706) | 0.0 | 0.386 | 0.879 |
 Female gender | B | 15 | 5399 | 1.479 (1.186–1.845) | 42.5 | 0.042 | 0.001 |
 Weight (per kg) | C | 2 | 288 | 1.021 (0.996–1.046) | 0.0 | 0.875 | 0.098 |
 BMI (per kg/m2) | C | 9 | 6558 | 1.080 (1.062–1.099) | 0.0 | 0.904 | 0.000 |
 Overweight | B | 5 | 2420 | 2.437 (1.629–3.646) | 56.4 | 0.057 | 0.000 |
 White race | B | 2 | 948 | 0.474 (0.303–0.740) | 0.0 | 0.337 | 0.001 |
 Hepatocellular carcinoma | B | 4 | 1027 | 0.681 (0.316–1.469) | 66.6 | 0.030 | 0.328 |
 Fulminant hepatic failure | B | 2 | 700 | 1.089 (0.114–10.444) | 77.4 | 0.036 | 0.941 |
 Alcoholic liver disease | B | 6 | 2320 | 1.747 (1.326–2.302) | 0.3 | 0.414 | 0.000 |
 Primary biliary cirrhosis | B | 2 | 466 | 0.657 (0.276–1.566) | 32.3 | 0.224 | 0.343 |
 Hepatitis B virus infection | B | 3 | 1367 | 0.710 (0.486–1.039) | 18.7 | 0.292 | 0.078 |
 Hepatitis C virus infection | B | 5 | 2930 | 1.113 (0.844–1.466) | 11.1 | 0.342 | 0.449 |
 Cirrhosis | B | 2 | 887 | 2.171 (1.322–3.566) | 0.0 | 0.518 | 0.002 |
 Refractory ascites | B | 4 | 685 | 2.293 (1.392–3.778) | 0.0 | 0.399 | 0.001 |
 Pre-existing diabetes mellitus | B | 13 | 5763 | 1.390 (1.199–1.611) | 0.0 | 0.480 | 0.000 |
 Preoperative hypertension | B | 10 | 5544 | 1.291 (0.814–2.045) | 64.7 | 0.003 | 0.278 |
 Preoperative use of diuretic | B | 2 | 998 | 2.733 (1.302–5.739) | 41.4 | 0.192 | 0.008 |
 Child-Turcotte-Pugh grade C | B | 4 | 2031 | 1.876 (1.205–2.922) | 76.7 | 0.005 | 0.005 |
 Child-Turcotte-Pugh score (per score) | C | 5 | 2371 | 1.272 (1.115–1.452) | 73.2 | 0.005 | 0.000 |
 MELD (per score) | C | 23 | 10,444 | 1.035 (1.024–1.045) | 38.7 | 0.031 | 0.000 |
 High MELD score | B | 7 | 2174 | 1.986 (1.474–2.676) | 8.7 | 0.363 | 0.000 |
 Preoperative eGFR (per ml/min/1.73m2) | C | 2 | 456 | 1.007 (1.000–1.015) | 0.0 | 0.785 | 0.050 |
 APACHE II (per score) | C | 3 | 596 | 1.067 (1.041–1.093) | 0.0 | 0.646 | 0.000 |
 Preoperative serum creatinine (per μmol/L) | C | 3 | 582 | 0.998 (0.952–1.046) | 88.6 | 0.000 | 0.931 |
 Preoperative serum creatinine (per mg/dL) | C | 6 | 2422 | 2.337 (1.215–4.497) | 81.0 | 0.000 | 0.011 |
 High preoperative serum creatinine | B | 5 | 5498 | 2.155 (1.219–3.811) | 67.2 | 0.016 | 0.008 |
 Preoperative serum albumin (per g/dL) | C | 2 | 3001 | 0.539 (0.460–0.632) | 0.0 | 0.740 | 0.000 |
 Preoperative hypoalbuminemia | B | 3 | 958 | 1.127 (0.259–4.905) | 96.1 | 0.000 | 0.874 |
 Preoperative hemoglobin (per g/dL) | C | 4 | 4278 | 0.888 (0.856–0.922) | 0.0 | 0.433 | 0.000 |
 Preoperative anemia | B | 3 | 1410 | 1.621 (1.073–2.449) | 24.5 | 0.266 | 0.022 |
Donor and graft factors | |||||||
 Cadaveric donor liver graft | B | 2 | 329 | 3.360 (1.549–7.289) | 0.0 | 0.927 | 0.002 |
 DCD organ | B | 3 | 1642 | 2.704 (1.938–3.772) | 0.0 | 0.996 | 0.000 |
 Donor age (per year) | C | 5 | 2170 | 1.004 (0.991–1.017) | 49.5 | 0.095 | 0.578 |
 Older donor age | B | 3 | 1470 | 1.213 (0.799–1.840) | 23.6 | 0.270 | 0.364 |
 Donor BMI ≥ 30 kg/m2 | B | 2 | 1309 | 2.672 (1.173–6.085) | 57.8 | 0.124 | 0.019 |
 Donor risk index (per point) | C | 2 | 1404 | 0.820 (0.485–1.388) | 0.0 | 0.448 | 0.460 |
 ABO-incompatible liver transplantation | B | 2 | 1274 | 2.761 (1.602–4.759) | 0.0 | 0.751 | 0.000 |
 Graft-recipient weight ratio | C | 3 | 3999 | 0.497 (0.370–0.667) | 0.0 | 0.830 | 0.000 |
 Low graft to recipient body weight ratio | B | 5 | 1565 | 1.902 (1.013–3.568) | 52.3 | 0.078 | 0.045 |
 Cold ischaemic time (per min) | C | 2 | 358 | 1.000 (0.990–1.010) | 0.0 | 1.000 | 1.000 |
 Cold ischaemic time (per hour) | C | 7 | 2887 | 1.064 (1.003–1.130) | 48.6 | 0.070 | 0.041 |
 Long cold ischaemic time | B | 3 | 5220 | 1.408 (0.907–2.187) | 73.1 | 0.024 | 0.128 |
 Warm ischaemic time (per min) | C | 7 | 3427 | 1.018 (1.007–1.029) | 53.6 | 0.044 | 0.001 |
 Long warm ischaemic time | B | 3 | 5220 | 1.411 (0.711–2.799) | 83.9 | 0.002 | 0.325 |
Surgical factors | |||||||
 Piggyback surgical technique | B | 3 | 903 | 0.556 (0.195–1.585) | 81.8 | 0.004 | 0.272 |
 Split liver transplantation | B | 2 | 1296 | 1.074 (0.655–1.759) | 34.4 | 0.217 | 0.777 |
 Venovenous bypass | B | 3 | 740 | 0.577 (0.086–3.865) | 95.2 | 0.000 | 0.571 |
 Intraoperative hypotension | B | 5 | 566 | 5.582 (3.934–7.920) | 0.0 | 0.898 | 0.000 |
 Intraoperative blood loss (per liter) | C | 5 | 1734 | 1.156 (1.022–1.308) | 90.1 | 0.000 | 0.021 |
 Large intraoperative blood loss | B | 6 | 5639 | 2.900 (1.495–5.627) | 83.1 | 0.000 | 0.002 |
 Intraoperative use of vasopressor | B | 13 | 4625 | 2.079 (1.492–2.899) | 70.3 | 0.000 | 0.000 |
 Intraoperative colloidal use | B | 3 | 495 | 2.447 (1.508–3.973) | 0.0 | 0.630 | 0.000 |
 Intraoperative RBC transfusion (per unit) | C | 15 | 8006 | 1.042 (1.025–1.059) | 76.9 | 0.000 | 0.000 |
 Intraoperative RBC transfusion (per liter) | C | 4 | 2253 | 1.196 (1.143–1.253) | 11.4 | 0.336 | 0.000 |
 Large intraoperative RBC transfusion | B | 11 | 3401 | 3.124 (1.986–4.914) | 72.8 | 0.000 | 0.000 |
 Intraoperative FFP transfusion (per unit) | C | 9 | 5202 | 1.027 (1.021–1.032) | 3.8 | 0.403 | 0.000 |
 Intraoperative platelet transfusion (per unit) | C | 3 | 1503 | 1.321 (0.863–2.024) | 69.3 | 0.039 | 0.200 |
 Intraoperative urine output (per mL) | C | 2 | 777 | 0.995 (0.986–1.003) | 96.8 | 0.000 | 0.232 |
 Postreperfusion syndrome | B | 9 | 4731 | 1.689 (1.275–2.236) | 52.8 | 0.031 | 0.000 |
 Duration of operation (per hour) | C | 4 | 1563 | 1.158 (1.008–1.330) | 65.9 | 0.032 | 0.038 |
 Long operation time | B | 2 | 738 | 1.485 (0.937–2.353) | 0.0 | 0.470 | 0.093 |
Postoperative factors | |||||||
 Postoperative hypotension | B | 2 | 173 | 6.127 (1.871–20.067) | 0.0 | 0.824 | 0.003 |
 Large postoperative RBC transfusion | B | 2 | 308 | 5.051 (2.387–10.691) | 0.0 | 0.899 | 0.000 |
 Postoperative use of vasopressor | B | 4 | 4903 | 2.234 (1.431–3.488) | 75.9 | 0.006 | 0.000 |
 Postoperative peak AST (per u/L) | C | 2 | 232 | 3.687 (1.081–12.575) | 79.7 | 0.026 | 0.037 |
 Postoperative peak AST (per IU/L) | C | 2 | 196 | 1.451 (0.618–3.410) | 84.2 | 0.012 | 0.393 |
 Overexposure to CNI | B | 2 | 4682 | 2.762 (1.737–4.391) | 0.0 | 0.857 | 0.000 |
 No combined use of mycophenolate mofetil | B | 3 | 5220 | 2.087 (1.404–3.103) | 0.0 | 0.899 | 0.000 |
 Postoperative tacrolimus peak level (per ug/L) | C | 3 | 1675 | 0.983 (0.951–1.017) | 50.0 | 0.135 | 0.326 |
 Postoperative tacrolimus use | B | 4 | 2891 | 1.522 (0.942–2.459) | 43.8 | 0.149 | 0.086 |
 Postoperative hypoalbuminemia | B | 2 | 1528 | 0.718 (0.261–1.976) | 95.6 | 0.000 | 0.522 |
 Graft dysfunction | B | 3 | 1744 | 3.124 (2.036–4.795) | 0.0 | 0.513 | 0.000 |
 Infection | B | 8 | 1651 | 3.162 (2.315–4.320) | 0.0 | 0.983 | 0.000 |