BACKGROUND Acute kidney injury (AKI) is a frequent complication after liver transplantation. Although numerous risk factors for AKI have been identified, their cumulative impact remains unclear. Our aim was therefore to design a new model to predict post-transplant AKI. METHODS Risk analysis was performed in patients undergoing liver transplantation in two centres (n = 1230). A model to predict severe AKI was calculated, based on weight of donor and recipient risk factors in a multivariable regression analysis according to the Framingham risk-scheme. RESULTS Overall, 34% developed severe AKI, including 18% requiring postoperative renal replacement therapy (RRT). Five factors were identified as strongest predictors: donor and recipient BMI, DCD grafts, FFP requirements, and recipient warm ischemia time, leading to a range of 0-25 score points with an AUC of 0.70. Three risk classes were identified: low, intermediate and high-risk. Severe AKI was less frequently observed if recipients with an intermediate or high-risk were treated with a renal-sparing immunosuppression regimen (29 vs. 45%; p = 0.007). CONCLUSION The AKI Prediction Score is a new instrument to identify recipients at risk for severe post-transplant AKI. This score is readily available at end of the transplant procedure, as a tool to timely decide on the use of kidney-sparing immunosuppression and early RRT.

中文翻译：

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AKI预测评分：肝移植后急性肾损伤的新预测模型。

背景技术急性肾损伤（AKI）是肝移植后的常见并发症。尽管已经确定了许多AKI危险因素，但它们的累积影响仍不清楚。因此，我们的目的是设计一个新模型来预测移植后的AKI。方法在两个中心（n = 1230）对接受肝移植的患者进行了风险分析。根据Framingham风险方案，在多变量回归分析中，基于供体和受体风险因素的权重，计算了一个预测严重AKI的模型。结果总体而言，有34％的人发生了严重的AKI，其中18％的患者需要术后肾脏替代治疗（RRT）。五个因素被确定为最强的预测因素：供体和受体的BMI，DCD移植物，FFP要求和受体的温暖缺血时间，导致得分范围为0-25，AUC为0.70。确定了三个风险类别：低，中和高风险。如果接受中度或高危接受者使用保留肾脏的免疫抑制方案，则观察到严重AKI的频率较低（29比45％； p = 0.007）。结论AKI预测评分是一种新的工具，可用来识别有严重移植后AKI风险的接受者。该分数可在移植过程结束时获得，作为及时决定使用保肾免疫抑制和早期RRT的工具。结论AKI预测评分是一种新的工具，可用来识别有严重移植后AKI风险的接受者。该分数可在移植过程结束时获得，作为及时决定使用保肾免疫抑制和早期RRT的工具。结论AKI预测评分是一种新的工具，可用来识别有严重移植后AKI风险的接受者。该分数可在移植过程结束时获得，作为及时决定使用保肾免疫抑制和早期RRT的工具。