ACUTE kidney injury affected nearly one-third of paediatric liver transplant recipients, with a meta-analysis identifying multiple perioperative and patient-related factors that may influence postoperative risk. The findings highlighted the importance of identifying patients at increased risk and strengthening management throughout the perioperative period.
Researchers systematically evaluated the incidence and potential risk factors for acute kidney injury (AKI) following paediatric liver transplantation. They searched PubMed, Cochrane Library, Web of Science, and Embase from inception to September 2025 for relevant observational studies.
The analysis included 17 retrospective cohort studies involving 2,986 paediatric liver transplant recipients. Two researchers independently performed literature screening, data extraction, and quality assessment, with study quality evaluated using the Newcastle–Ottawa Scale.
The pooled incidence of AKI following paediatric liver transplantation was 30.7% (95% CI: 25.0–36.3%).
Several patient-related and perioperative factors may be associated with postoperative AKI. These included preoperative hepatic impairment, coagulation abnormalities, inadequate nutrition and oxygen delivery, intraoperative blood loss, transfusion burden, ischaemia–reperfusion injury, and the requirement for continuous postoperative organ support.
However, many individual risk factors were assessed in only a small number of studies. The corresponding pooled estimates therefore require cautious interpretation.
Sensitivity analyses indicated that the overall pooled estimates were robust, while the impact of publication bias was minimal.
The relatively high incidence of AKI identified following paediatric liver transplantation underlined the potential importance of comprehensive risk assessment across the perioperative period.
The researchers highlighted early identification of patients at high risk and targeted interventions as priorities for reducing AKI risk and improving clinical outcomes. Management throughout the entire perioperative period should also be strengthened based on the findings.
Nevertheless, evidence supporting many individual risk factors remained limited by the small number of contributing studies. The researchers therefore called for further large-scale prospective studies to validate the reported associations and inform risk-stratified perioperative management.
Reference
Cai W et al. Risk factors for acute kidney injury after pediatric liver transplantation: a systematic review and meta-analysis. Eur J Ped. 2026;185(764). https://doi.org/10.1007/s00431-026-07419-y
Image credit: Goncharuk_film on Adobestock
Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.
