Acute kidney injury after major hepatectomy: association with postoperative complications and post-hepatectomy liver failure
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
Source: BJS Open
Authors: Oskar Swartling, Tim Reese, Kristina Hasselgren, Jennie Engstrand, Anna Emilia Kern, Ruth Baumgartner, Poya Ghorbani, Per Sandström, Ernesto Sparrelid, Karl J Oldhafer, Bergthor Björnsson, Stefan Gilg
Language: English
Topic: Acute Kidney Injury Research
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,881
Funder: Radiumhemmets Forskningsfonder
OpenAlex ID: W7140205268