TY - JOUR
T1 - Kidney injury and status 1 liver transplantation
T2 - Outcomes, kidney function, and listing for kidney transplantation
AU - Cloonan, Daniel J.
AU - Cloonan, Madeline R.
AU - Westphal, Scott G.
AU - Dageforde, Leigh Anne
AU - Merani, Shaheed
N1 - Publisher Copyright:
© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
PY - 2023/4
Y1 - 2023/4
N2 - Background: Effects of kidney injury (KI) at the time of liver transplantation (LT) for acute liver failure (ALF) remain poorly described. We hypothesized that patients with ALF and KI who undergo LT have persistent post-transplant KI, inferior survival, and increased rate of kidney transplantation (KT). Methods: The US Scientific Registry of Transplant Recipients database was queried for patients transplanted with status 1 listing for LT between 2002 and 2021. KI was defined as estimated glomerular filtration rate (eGFR) ≤ 30 mL/min/1.73 m2 or dialysis in the week prior to LT. Outcomes evaluated were post-LT eGFR, listing for subsequent KT, and overall survival (OS) after LT. Results: A total of 2984 patients underwent LT for ALF with 1241 (41.6%) having KI. KI patients had lower eGFR at 6 months post-LT (57.8 vs. 68.7, p <.001) that persisted out to 5 years (59.9 vs. 69.7, p <.001). KI patients were more likely to be listed for KT (4.3% vs. 1.9%, p <.001) and undergo listing sooner after LT (.8 vs. 3.7 years, p <.001). Patients without KI had higher adjusted post-transplant OS compared to those with KI (HR.75, p <.001). Conclusion: KI in the setting of ALF portends a worse prognosis for both kidney recovery and OS.
AB - Background: Effects of kidney injury (KI) at the time of liver transplantation (LT) for acute liver failure (ALF) remain poorly described. We hypothesized that patients with ALF and KI who undergo LT have persistent post-transplant KI, inferior survival, and increased rate of kidney transplantation (KT). Methods: The US Scientific Registry of Transplant Recipients database was queried for patients transplanted with status 1 listing for LT between 2002 and 2021. KI was defined as estimated glomerular filtration rate (eGFR) ≤ 30 mL/min/1.73 m2 or dialysis in the week prior to LT. Outcomes evaluated were post-LT eGFR, listing for subsequent KT, and overall survival (OS) after LT. Results: A total of 2984 patients underwent LT for ALF with 1241 (41.6%) having KI. KI patients had lower eGFR at 6 months post-LT (57.8 vs. 68.7, p <.001) that persisted out to 5 years (59.9 vs. 69.7, p <.001). KI patients were more likely to be listed for KT (4.3% vs. 1.9%, p <.001) and undergo listing sooner after LT (.8 vs. 3.7 years, p <.001). Patients without KI had higher adjusted post-transplant OS compared to those with KI (HR.75, p <.001). Conclusion: KI in the setting of ALF portends a worse prognosis for both kidney recovery and OS.
KW - acute liver failure
KW - kidney injury after liver transplantation
KW - liver transplantation
KW - organ allocation
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U2 - 10.1111/ctr.14921
DO - 10.1111/ctr.14921
M3 - Article
C2 - 36722340
AN - SCOPUS:85148026673
SN - 0902-0063
VL - 37
JO - Clinical Transplantation
JF - Clinical Transplantation
IS - 4
M1 - e14921
ER -