Abstract
This study sought to systematically evaluate the incidence rates and risk factors of acute kidney injury (AKI) following pediatric liver transplantation (PLT), providing robust evidence for early identification of high-risk pediatric patients and development of perioperative intervention strategies. PubMed, Cochrane Library, Web of Science, and Embase were searched from their inception to September 2025 for observational studies on risk factors for AKI following PLT. Literature screening, data extraction, and quality assessment were independently completed by two researchers. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of included studies. Meta-analysis was conducted using StataMP 17.0. In total, 17 retrospective cohort studies were included, involving 2986 pediatric liver transplant recipients. The pooled incidence rate of AKI following PLT was 30.7% [95% CI (25.0%, 36.3%)]. Several perioperative and patient-related factors may be associated with postoperative AKI. However, many of these factors were evaluated in only a small number of studies, and the corresponding pooled estimates should therefore be interpreted cautiously. Sensitivity analyses showed that the overall pooled estimates were robust, and the impact of publication bias was minimal. Conclusion: The incidence rate of AKI following PLT is relatively high. Furthermore, its occurrence is influenced by multiple factors, including preoperative hepatic impairment, coagulation abnormalities, inadequate nutrition and oxygen delivery, intraoperative blood loss, transfusion burden, and ischemia-reperfusion injury, and the requirement for continuous postoperative organ support. Clinically, comprehensive risk assessment and management across the entire perioperative period should be strengthened. Moreover, early identification of high-risk patients and implementation of targeted interventions should be prioritized to reduce the risk of AKI and improve clinical outcomes. However, the evidence for many individual factors was derived from a limited number of studies and should be interpreted cautiously. Further large-scale prospective studies are needed to validate these associations and guide risk-stratified perioperative management.