Acute kidney injury after major hepatectomy: association with postoperative complications and post-hepatectomy liver failure

TL;DR

This study shows that acute kidney injury after major liver surgery is common and increases the risk of severe complications and death.

Contribution

The study identifies AKI as a significant predictor of post-hepatectomy liver failure and mortality.

Findings

25.6% of patients undergoing major hepatectomy developed acute kidney injury.

AKI was strongly associated with post-hepatectomy liver failure and increased 90-day mortality.

AKI risk factors included male sex, older age, and low preoperative kidney function.

Abstract

Patients undergoing liver resections are at increased risk of acute kidney injury (AKI). The objective of this study was to examine AKI after major hepatectomy and the associated risk of adverse postoperative outcomes, including post-hepatectomy liver failure (PHLF) and mortality.

All adult patients undergoing major hepatectomy between 2010 and 2021 at three tertiary referral centres in Sweden and Germany were included. Postoperative AKI was based on standardized criteria using serum creatinine and urine output. Logistic regression models were used to explore associations with adverse events.

In all, 1561 patients were included in the study, of whom 400 (25.6%) developed AKI of any grade. Risk factors for AKI included male sex, higher age, and a low preoperative estimated glomerular filtration rate. Patients with AKI were at increased risk of intensive care unit admission (adjusted odds ratio (aOR) 6.06; 95% confidence interval (c.i.) 2.83 to 12.95), Clavien–Dindo grade ≥ IIIa (aOR 2.08; 95% c.i. 1.61 to 2.67) and PHLF grade B or C (aOR 2.87; 95% c.i. 2.11 to 3.90). Patients with only AKI and patients with both AKI and PHLF grade B or C had an increased risk of 90-day mortality than patients with neither. Postoperative AKI was associated with an increased risk of 90-day mortality even after adjustment for PHLF.

AKI after major hepatectomy is a common complication and is associated with considerable morbidity and mortality. Postoperative AKI may be both an early risk factor for PHLF after major hepatectomy and independently contribute to 90-day mortality.

This study explored early acute kidney injury after major hepatectomy and its association with post-hepatectomy liver failure. One-quarter of all included patients developed early acute kidney injury, and these patients were also more likely to later experience post-hepatectomy liver failure.