Overview of Pre and Intraoperative Risk Factors for Acute Kidney Injury after Deceased-Donor Liver Transplantation

Abstract Acute Kidney Injury (AKI) is characterized by the abrupt loss, or a worsening of the kidney function, which has serious consequences on the prognosis of patients undergoing Liver Transplantation (LT). Identifying pre and intraoperative risk factors for the occurrence of the AKI after Deceased-Donor Liver Transplantation (DDLT) enables potential interventions on patients at risk immediately after the end of the surgery. The MELD score, preoperative renal dysfunction, graft macrosteatosis, Extended Criteria Donors (ECD), Intraoperative Arterial Hypotension (IOAH) with compromised tissue perfusion, and intraoperative Massive Blood Transfusion (MBT) have already been highlighted as strong predictors of postoperative AKI. Moreover, the definition of AKI to be adopted in this population must be uniform, and it would be reasonable that diagnostic and staging AKI criteria must consider haemodynamic repercussions of cirrhosis. Finally, AKI is a very common complication after DDLT, and identifying potential pre and intraoperative risk factors may lead to a construction of an effective model risk that would ultimately aim to improve perioperative management of these patients in risk, preventing this serious complication. Keywords Acute kidney injury; Deceased-donor; Liver transplantation; Risk factors