الفهرس 
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Abstract
Liver transplant is a surgical procedure that removes a liver that no longer functions properly (liver failure) and replaces it with a healthy liver from a deceased donor or a portion of a healthy liver from a living donor.
Acute kidney injury (AKI) is a common complication in the immediate postoperative period of patients undergoing liver transplantation, with varying incidence. Past studies have found AKI in 12% to 95% of patients after liver transplantation, with 8%-17% requiring renal replacement therapy, and it is associated with worse outcomes.
Classification of AKI includes pre-renal AKI, acute post-renal obstructive nephropathy and intrinsic acute kidney diseases. Of these, only ‘intrinsic’ AKI represents true kidney disease, while pre-renal and post-renal AKI are the consequence of extra-renal diseases leading to the decreased glomerular filtration rate (GFR). If these pre- and/or post-renal conditions persist, they will eventually evolve to renal cellular damage and hence intrinsic renal disease.
AKI etiology after liver transplantation is variable and depends on multiple factors, as acute tubular necrosis secondary to renal ischemia, drug nephrotoxicity (antibiotics and immunosuppressants), and previous patients’ clinical conditions related to the degree of hepatic decompensation or the presence of hepatorenal syndrome.
The current study aimed to evalute the prevalence of acute kidney injury (AKI), its risk factors and outcome after liver transplantation in The National Liver Institute in Menoufia, Egypt from living Egyptian donor.
To elucidate our aim, this was an observational, cross-sectional, study carried out on 85 adult patients (age >18) prospectively for new patients who candidate for liver transplantation (LT) and also retrospectively for already transplanted patients Since 3 yeears attended to National Liver Institute (NLI), Menoufia University, Shebin El Kom, EGYPT during the period from December 2018 to September 2021.
People included in this study were divided into two groups as follow: group I: included 47 patients without acute kidney injury (non-Renal). group II: Included 38 patient with acute kidney injury (Renal).
Patients in group II were subclassified into subgroups according to their outcome during post transplantation follow up: group IIa: Included 22 patients who survival and group IIb: Included 16 patients who were died.
For every patient the following was done: Preoperative Data: Full and detailed history: Full medical history was taken with special stress on age, sex, occupation, residence, special habits, diabetes mellitus, hypertension, cause of liver disease, virology (HCV-HBV-HIV), type of recent drugs, history of cardiac diseases, family history, past medical and surgical history. Physical examination: Thorough clinical examination was performed for each patient. Routine investigations: Complete blood count, Random blood glucose levels, HbA1c %, kidney functions (blood urea, creatinine, uric acid, e GFR, urine analysis), liver functions (AST, ALT, Bilirubin total and direct, P.T. and serum albumin), serum calcium and phosphorous, serum sodium and potassium, total serum cholesterol, triglycerides, LDL and HDL,model for End-stage Liver Disease (MELD)score. Operative data: Bleeding, blood transfusion required or any complications.
Diagnosis of AKI is made according to KDIGO (2012) Criteria: Stage 1: Increase in SCr ≥ 0.3 mg/dL (in 48 hours) or an increase in SCr to 1.5 to 1.9 times baseline, which is known or presumed to have occurred within 7 days before, or a urine volume of less than 0.5 mL/kg per hour for 6 hours.; Stage 2: 2.0 to 2.9 multiplied by baseline SCr; Stage 3: 3.0 or more multiplied by baseline; increase in SCr ≥ 4.0 mg/dL; or beginning of renal replacement therapy regardless of a previous KDIGO stage.