Introduction
Experimental procedures
Source of data and participants
Perioperative treatment
Outcome
Predictors and selection
Statistics
Results
Baseline characteristics of the participants
All (N = 780) | Non-AKI (n = 350) | AKI(n = 430) | P value | |
---|---|---|---|---|
Age (y) | 50.719 (10.638) | 51.051 (10.433) | 50.449 (10.808) | 0.295 |
Height (cm) | 167.954 (9.065) | 167.734 (6.428) | 168.134 (10.753) | 0.052 |
Weight (kg) | 64.628 (11.304) | 63.404 (10.889) | 65.628 (11.548) | 0.004 |
Body Mass Index | 22.782 (3.574) | 22.539 (3.529) | 22.98 (3.602) | 0.018 |
Preoperative LOS (d) | 11 (2–26) | 14 (4–28) | 8 (2–23) | 0.001 |
Diagnosis of AKI | ||||
No AKI | 350.0 (100.0%) | / | ||
Stage 1 AKI | / | 177.0 (41.163%) | ||
Stage 2 AKI | / | 63.0 (14.651%) | ||
Stage 3 AKI | / | 190.0 (44.186%) | ||
Stage 3 AKI requring CRRT | / | 159.0 (36.977%) | ||
AKI diagnosis during POD1 | / | 288 (66.977%) | ||
Preoperative renal function | ||||
CKD (n) | 121.0 (15.513%) | 49.0 (14.0%) | 72.0 (16.744%) | 0.34 |
AKI (n) | 172.0 (22.051%) | 67.0 (19.143%) | 105.0 (24.419%) | 0.093 |
HRS (n) | 33.0 (4.231%) | 8.0 (2.286%) | 25.0 (5.814%) | 0.024 |
SCr (μmol/L) | 91.777 (70.334) | 92.388 (68.852) | 91.28 (71.593) | 0.047 |
BUN (mmol/L) | 6.846 (5.823) | 6.56 (5.218) | 7.078 (6.268) | 0.985 |
eGFR (ml/(min*1.732)) | 95.029 (32.145) | 93.749 (29.966) | 96.07 (33.813) | 0.127 |
SCr_Mean (μmol/L) | 79.343 (71.641) | 75.837 (65.256) | 82.197 (76.402) | 0.917 |
Use of CRRT (n) | 94.0 (12.051%) | 24.0 (6.857%) | 70.0 (16.279%) | < 0.001 |
Frequency of CRRT (times) | 2.567 (10.727) | 1.351 (8.312) | 3.556 (12.269) | < 0.001 |
Preoperative laboratory values | ||||
HCT | 0.299 (0.076) | 0.312 (0.08) | 0.288 (0.07) | < 0.001 |
PLT(109/L) | 96.026 (79.4) | 116.597 (95.149) | 79.281 (58.79) | < 0.001 |
ALT (U/L) | 126.282 (399.834) | 90.349 (235.856) | 155.53 (493.081) | 0.004 |
AST (U/L) | 172.242 (538.996) | 148.429 (369.227) | 191.626 (644.817) | < 0.001 |
TBIL (μmol/L) | 250.278 (249.713) | 172.311 (217.596) | 313.739 (256.351) | < 0.001 |
DBIL (μmol/L) | 159.74 (168.516) | 116.107 (152.227) | 195.256 (172.907) | < 0.001 |
IBIL (μmol/L) | 90.537 (96.523) | 56.204 (72.764) | 118.483 (104.24) | < 0.001 |
ALB (g/L) | 35.668 (4.906) | 36.212 (5.283) | 35.225 (4.535) | 0.023 |
PT (s) | 25.16 (13.483) | 21.115 (9.851) | 28.452 (15.064) | < 0.001 |
APTT (s) | 54.653 (20.923) | 49.183 (16.041) | 59.105 (23.267) | < 0.001 |
FIB (g/L) | 1.982 (1.422) | 2.357 (1.372) | 1.676 (1.39) | < 0.001 |
INR | 2.339 (1.574) | 1.912 (1.397) | 2.686 (1.625) | < 0.001 |
Etiology of liver | ||||
Hepatitis B (n) | 577.0 (73.974%) | 257.0 (73.429%) | 320.0 (74.419%) | 0.817 |
Hepatitis C (n) | 17.0 (2.179%) | 11.0 (3.143%) | 6.0 (1.395%) | 0.157 |
Dual infection (n) | 9.0 (1.154%) | 5.0 (1.429%) | 4.0 (0.93%) | 0.756 |
Hepatic Malignancy (n) | 312.0 (40.0%) | 190.0 (54.286%) | 122.0 (28.372%) | < 0.001 |
Cirrhosis (n) | 623.0 (79.872%) | 292.0 (83.429%) | 331.0 (76.977%) | 0.032 |
Preoperative complications | ||||
MELD score | 24 (22–35) | 22(22–29) | 30 (22–38) | < 0.001 |
Portal hypertension (n) | 407.0 (52.179%) | 192.0 (54.857%) | 215.0 (50.0%) | 0.201 |
Ascites (n) | 321.0 (41.154%) | 142.0 (40.571%) | 179.0 (41.628%) | 0.822 |
HE (n) | 180.0 (23.077%) | 41.0 (11.714%) | 139.0 (32.326%) | < 0.001 |
Plasmapheresis (n) | 7.0 (0.897%) | 2.0 (0.571%) | 5.0 (1.163%) | 0.625 |
HPS (n) | 4.0 (0.513%) | 1.0 (0.286%) | 3.0 (0.698%) | 0.766 |
ARDS (n) | 7.0 (0.897%) | 3.0 (0.857%) | 4.0 (0.93%) | 0.784 |
ALI (n) | 0.0 (0.0%) | 0.0 (0.0%) | 0.0 (0.0%) | 1 |
MV (n) | 49.0 (6.282%) | 9.0 (2.571%) | 40.0 (9.302%) | < 0.001 |
ICU stay (n) | 439.0 (56.282%) | 164.0 (46.857%) | 275.0 (63.953%) | < 0.001 |
Hypernatremia (n) | 44.0 (5.641%) | 10.0 (2.857%) | 34.0 (7.907%) | 0.004 |
Metabolic acidosis (n) | 336.0 (43.077%) | 144.0 (41.143%) | 192.0 (44.651%) | 0.362 |
Donor characteristics | ||||
Donor age (y) | 39.191 (13.966) | 38.894 (14.392) | 39.433 (13.621) | 0.755 |
Donor BMI | 22.578 (3.199) | 22.336 (3.185) | 22.779 (3.201) | 0.074 |
ABO incompatibility (n) | 120.0 (15.385%) | 38.0 (10.857%) | 82.0 (19.07%) | 0.002 |
Donor Type | 0.248 | |||
DBD (n) | 448 (57.436%) | 212 (60.571%) | 236 (54.884%) | |
DCD (n) | 324 (41.538%) | 134 (38.286%) | 190 (44.186%) | |
DBCD (n) | 8 (1.026%) | 4 (1.143%) | 4 (0.93%) | |
Steatosis of donor liver | 0.002 | |||
Steatosis grade 0 (n) | 529 (67.821%) | 260.0 (74.286%) | 269 (62.558%) | |
Steatosis grade 1 (n) | 170 (21.795%) | 62.0 (17.714%) | 108 (25.116%) | |
Steatosis grade 2 (n) | 35 (4.487%) | 9.0 (2.571%) | 26 (6.047%) | |
Steatosis grade 3 (n) | 1 (0.128%) | 0.0 (0.0%) | 1 (0.233%) | |
Steatosis grade ≥ 1 | 206.0 (26.41%) | 71.0 (20.286%) | 135.0 (31.395%) | 0.001 |
Steatosis grade ≥ 2 | 36.0 (4.615%) | 9.0 (2.571%) | 27.0 (6.279%) | 0.022 |
Lack of pathology assesment (n) | 45 (5.769%) | 19 (5.429%) | 26 (6.046%) | 0.721 |
Surgery characteristics | ||||
Time of surgery (min) | 442.713 (92.854) | 425.297 (87.949) | 456.888 (94.418) | < 0.001 |
Time under anesthesia (min) | 538.888 (97.864) | 519.56 (92.679) | 554.621 (99.251) | < 0.001 |
Recipient warm ischemic time (min) | 46.45 (12.035) | 45.919 (12.183) | 46.883 (11.909) | 0.088 |
Cold ischemic time (h) | 6.255 (1.358) | 6.226 (1.393) | 6.278 (1.329) | 0.476 |
Surgical technique | 0.304 | |||
Piggyback (n) | 713 (91.41%) | 317 (90.571%) | 396 (92.093%) | |
Split liver (n) | 36 (4.615%) | 15 (4.286%) | 21 (4.884%) | |
Standard (n) | 31 (3.974%) | 18 (5.143%) | 13 (3.023%) | |
Intraoperative fluid and transfusion | ||||
Crystalloid (ml) | 2618.423 (2240.489) | 2775.575 (2366.817) | 2490.944 (2126.798) | 0.094 |
Colloid (ml) | 124.26 (427.879) | 153.448 (424.742) | 100.583 (429.443) | 0.006 |
Albumin (ml) | 218.295 (116.74) | 222.629 (111.083) | 214.779 (121.15) | 0.483 |
Transfusion | ||||
RBC (ml) | 1500.39 (1318.45) | 1279.989 (1333.507) | 1679.177 (1280.024) | < 0.001 |
Plasma (ml) | 1862.806 (1613.71) | 1725.862 (1376.393) | 1973.893 (1777.029) | 0.063 |
Cryoprecipitate (U) | 30.276 (15.83) | 27.359 (14.9) | 32.653 (16.182) | < 0.001 |
EBL (ml) | 2051.489 (2027.519) | 1679.857 (1890.832) | 2354.685 (2086.165) | < 0.001 |
Urine output (ml·kg−1·h−1) | 3.104 (2.146) | 3.708 (2.219) | 2.613 (1.954) | < 0.001 |
Ascites removal (ml) | 959.665 (1889.757) | 947.011 (1997.938) | 969.93 (1799.531) | 0.196 |
Intraoperative medication | ||||
rFVIIa (mg) | 0.346 (1.127) | 0.211 (1.03) | 0.455 (1.19) | < 0.001 |
Prothrombin complex concentrate (IU) | 587.692 (433.693) | 554.857 (434.497) | 614.419 (431.7) | 0.043 |
Fibrinogen (g) | 0.404 (1.293) | 0.342 (0.735) | 0.453 (1.609) | 0.567 |
Terlipressin (mg) | 0.322 (0.551) | 0.195 (0.447) | 0.426 (0.604) | < 0.001 |
Norepinephrine, bolus (mg) | 0.008 (0.022) | 0.006 (0.018) | 0.009 (0.024) | 0.353 |
Epinephrine, bolus (mg) | 0.028 (0.299) | 0.011 (0.161) | 0.042 (0.376) | 0.785 |
Dopamine, bolus (mg) | 12.0 (1.538%) | 4.0 (1.143%) | 8.0 (1.86%) | 0.874 |
Bicarbonate (ml) | 127.006 (234.266) | 89.429 (221.225) | 157.593 (240.316) | < 0.001 |
Use of norepinephrine, continuous (n) | 649.0 (83.205%) | 301.0 (86.0%) | 348.0 (80.93%) | 0.074 |
Use of epinephrine, continuous (n) | 553.0 (70.897%) | 250.0 (71.429%) | 303.0 (70.465%) | 0.829 |
Use of dopamine, continuous (n) | 245.0 (31.41%) | 106.0 (30.286%) | 139.0 (32.326%) | 0.594 |
Use of aramine (n) | 34.0 (4.359%) | 7.0 (2.0%) | 27.0(6.279%) | 0.006 |
Intraoperative incident | ||||
Cardiac arrest (n) | 21.0 (2.692%) | 3.0 (0.857%) | 18.0(4.186%) | 0.008 |
Acidosis (n) | 322.0 (41.282%) | 133.0 (38.0%) | 189.0 (43.953%) | 0.108 |
Hypotension (n) | 649.0 (83.205%) | 298.0 (85.143%) | 351.0 (81.628%) | 0.226 |
Internal validation performance
Temporal external validation
Characteristics | Development set (n = 546) | Temporal validation set (n = 195) | P values |
---|---|---|---|
Diagnosis of post-LT AKI | 301 (55.13%) | 98 (50.26%) | 0.867 |
Demographics | |||
Gender (male, n) | 472 (86.45%) | 171 (87.69%) | 1 |
Age (y) | 50.61 (10.76) | 47.02 (10.07) | < 0.001 |
Height (cm) | 167.77 (9.55) | 168.55 (6.42) | 0.292 |
Weight (kg) | 64.25 (11.42) | 65.13 (11.14) | 0.35 |
BMI | 22.71 (3.33) | 23.09 (3.06) | 0.164 |
Predicting variables | |||
IBIL (μmol/L) | 90.34 (97.04) | 96.91 (109.27) | 0.433 |
UO (ml/(kg*h)) | 3.09 (2.2) | 3.03 (1.99) | 0.73 |
Time under GA(min) | 543.0 (121.0) | 498.86 (111.18) | < 0.001 |
PLT(109/L) | 94.45 (80.83) | 93.89 (76.62) | 0.932 |
Steatosis grade ≥ 1 | 147 (26.92%) | 85 (43.59%) | 0.001 |
Preoperative LOS (d) | 18.23 (21.82) | 15.78 (21.13) | 0.175 |
EBL (ml) | 2066.38 (1906.18) | 1559.1 (1918.04) | 0.002 |
ALB (g/L) | 35.56 (4.89) | 34.74 (6.96) | 0.133 |
Bicarbonate (ml) | 124.04 (211.47) | 169.92 (203.77) | 0.009 |
Colloid (ml) | 111.24 (301.53) | 32.31 (117.68) | < 0.001 |
Pre-operative HE (n) | 129 (23.63%) | 37 (18.97%) | 0.899 |
Cryoprecipitate(U) | 30.46 (16.03) | 26.53 (15.13) | 0.003 |
ALT (U/L) | 131.08 (433.19) | 72.26 (211.4) | 0.069 |
Pre-operative HM (n) | 209 (38.28%) | 91 (46.67%) | 0.249 |