Arterial Blood Pressure at Liver Transplant Evaluation Predicts Renal Histology in Candidates With Renal Dysfunction

Wadei, Hani M.; Abader, Peter; Alsaad, Ali A.; Croome, Kristopher P.; Cortese, Cherise; Geiger, Xochiquetzal J.; Khouzam, Samir; Martin, L.; Taner, C. Burcin; Keaveny, Andrew P.

doi:10.1002/lt.25651

Cited by 12 publications

(7 citation statements)

References 26 publications

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“…The relatively high preoperative serum creatinine may result from the unavoidable whole body ischemia occurring during OLT (8,19). To prioritize the blood supply to other important organs, a transitory insufficient supply to the kidney may occur, causing tubular necrosis (20). This study is limited by its single-center, retrospective design and only moderate number of participants.…”

Section: Discussionmentioning

confidence: 99%

Chronic severe hepatitis and preoperative creatinine are independent risk factors for acute kidney injury after liver transplantation

Chen¹,

Mu²,

Wang³

et al. 2020

Ann Transl Med

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Background: Orthotopic liver transplantation (OLT) offers the highest chance of cure in comparison with all other treatment for liver tumors and other end stage liver disease. However, the complications caused by liver transplantation significantly affect its therapeutic effect, and acute kidney injury (AKI) is one of the most common of these. It is, therefore, necessary to identify the risk factors of AKI after liver transplantation.Methods: A single-center, retrospective study of patients receiving liver transplantation at the Beijing Chao-Yang Hospital between January 2015 to January 2019 was conducted.Patients were divided into a normal control group and AKI group based on their previous medical history.Preoperative and intraoperative indicators including preoperative creatinine, uric acid, and the intraoperative input of protein were then recorded.Results: A total of 419 patients were enrolled into the study. The control group consisted of 336 patients while 83 patients formed an AKI group based on the grading criteria of AKI. There were significant differences in chronic severe hepatitis (P=0.001), liver cancer (P=0.044), intraoperative input of sodium bicarbonate (P=0.019), input of red blood cell suspension (P=0.004), the input of blood plasma (P=0.043), intraoperative urine output (P=0.006), and preoperative creatinine (P=0.041) between the control and AKI group. Multivariate analysis indicated that chronic severe hepatitis (OR: 2.872; P=0.003) and preoperative creatinine (OR: 1.083; P=0.011) were independent risk factors for AKI in patients receiving liver transplantation.Conclusions: Chronic severe hepatitis and preoperative creatinine may be potential risk factors for the occurrence of AKI after liver transplantation.

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Section: Discussionmentioning

confidence: 99%

Chronic severe hepatitis and preoperative creatinine are independent risk factors for acute kidney injury after liver transplantation

Chen¹,

Mu²,

Wang³

et al. 2020

Ann Transl Med

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“…Post-LT immunosuppression management has previously been described and did not vary during the 20-year study period. (16,17) Briefly, the renal dysfunction group (Cr >1.5 or on RRT) received induction treatment with an interleukin-2 receptor blocker with delayed calcineurin inhibitor (CNI) introduction, whereas the patients without renal dysfunction received no induction treatment. Intravenous methylprednisolone starting from the day of the surgery was given for 4 to 5 doses followed by oral prednisone, which was tapered to 5 mg/day and later discontinued by the fourth post-LT month.…”

Section: Post-lt Managementmentioning

confidence: 99%

Post–Liver Transplant Early Allograft Dysfunction Modifies the Effect of Pre–Liver Transplant Renal Dysfunction on Post–Liver Transplant Survival

et al. 2021

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Pre-liver transplantation (LT) renal dysfunction is associated with poor post-LT survival. We studied whether early allograft dysfunction (EAD) modifies this association. Data on 2,856 primary LT recipients who received a transplant between 1998 and 2018 were retrospectively reviewed. Patients who died within the first post-LT week or received multiorgan transplants and previous LT recipients were excluded. EAD was defined as (1) total bilirubin ≥ 10 mg/dL on postoperative day (POD) 7, (2) international normalized ratio ≥1.6 on POD 7, and/or (3) alanine aminotransferase or aspartate aminotransferase ≥2000 IU/mL in the first postoperative week. Pre-LT renal dysfunction was defined as serum creatinine >1.5 mg/dL or on renal replacement therapy at LT. Patients were divided into 4 groups according to pre-LT renal dysfunction and post-LT EAD development. Recipients who had both pre-LT renal dysfunction and post-LT EAD had the worst unadjusted 1-year, 3-year, and 5-year post-LT patient and graft survival, whereas patients who had neither renal dysfunction nor EAD had the best survival (P < 0.001). After adjusting for multiple factors, the risk of death was significantly higher only in those with both pre-LT renal dysfunction and post-LT EAD (adjusted hazard ratio [aHR], 2.19; 95% confidence interval [CI], 1.58-3.03; P < 0.001), whereas those with renal dysfunction and no EAD had a comparable risk of death to those with normal kidney function at LT (aHR, 1.12; 95% CI, 0.86-1.45; P = 0.41). Results remained unchanged when pre-LT renal dysfunction was redefined using different glomerular filtration rate cutoffs. Pre-LT renal dysfunction negatively impacts post-LT survival only in patients who develop EAD. Livers at higher risk of post-LT EAD should be used with caution in recipients with pre-LT renal dysfunction.

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“…[2,3] However, the decision to proceed with SLK is not always clear. [4] Indeed, in some patients with severe acute kidney injury (AKI) related to hepatorenal syndrome, improvement in kidney function can occur following LT. [5] Brennan et al [6] demonstrated that up to 87% of patients with renal dysfunction who received LT had improvement in renal function within 1 month of transplant and that the prevalence of stage 4 or 5 chronic kidney disease after 1 year was as low as 6.8%. Similarly, a meta-analysis of 38 studies found that only 7% of patients undergoing LT had AKI necessitating dialysis postoperatively.…”

Section: Introductionmentioning

confidence: 99%

Improved outcomes of kidney after liver transplantation after the implementation of the safety net policy

Attieh,

Ibrahim,

Ghali

et al. 2023

Liver Transplantation

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The number of kidney after liver transplants (KALT) increased after the implementation of the United Network of Organ Sharing (UNOS) safety net policy, but the effects of the policy on KALT outcomes remain unknown. Using the UNOS database, we identified KALT between 60 and 365 days from liver transplant from January 1, 2010, to December 31, 2020. The main outcome was 1- and 3-year patient, liver, and kidney graft survival. Secondary outcomes included 6-month and 1-year acute rejection (AR) of liver and kidney, and 1-year kidney allograft function. Of the 256 KALT, 90 were pre-policy and 166 post-policy. Compared to pre-policy, post-policy 1- and 3-year liver graft survival was higher (54% and 54% vs. 86% and 81%, respectively, p<0.001), while 1- and 3-year kidney graft survival (99% and 75% vs. 92% and 79%, respectively, p=0.19), and 1- and 3-year patient survival (99% and 99% vs. 95% and 89%, respectively, p=0.11) were not significantly different. Subgroup analysis revealed similar trends in patients with and without renal failure at liver transplant. Liver AR at 6 months was lower post-policy (6.3% vs. 18.3%, p=0.006) but was similar (10.5% vs. 13%, p=0.63) at 1 year. Kidney AR was unchanged post-policy at 6 months and 1 year. Creatinine at 1 year did not differ post-policy versus pre-policy (1.4 vs. 1.3 mg/dL, p=0.07) despite a higher proportion of deceased donors, higher Kidney Donor Profile Index, and longer kidney cold ischemia time post-policy (p<0.05 for all). This 3-year follow-up after the 2017 UNOS policy revision demonstrated that the safety net implementation has resulted in improved liver outcomes for patients who underwent KALT with no increased AR of the liver or the kidney allografts.

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Arterial Blood Pressure at Liver Transplant Evaluation Predicts Renal Histology in Candidates With Renal Dysfunction

Cited by 12 publications

References 26 publications

Chronic severe hepatitis and preoperative creatinine are independent risk factors for acute kidney injury after liver transplantation

Chronic severe hepatitis and preoperative creatinine are independent risk factors for acute kidney injury after liver transplantation

Post–Liver Transplant Early Allograft Dysfunction Modifies the Effect of Pre–Liver Transplant Renal Dysfunction on Post–Liver Transplant Survival

Improved outcomes of kidney after liver transplantation after the implementation of the safety net policy

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