Chronic Kidney Disease After Liver Transplantation for Acute Liver Failure Is Not Associated With Perioperative Renal Dysfunction

Leithead, Joanna A.; Ferguson, James; Bates, C.M.; Davidson, J.; Simpson, Kenneth J.; Hayes, Peter

doi:10.1111/j.1600-6143.2011.03649.x

Cited by 24 publications

(27 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The need for RRT has also been identified as an independent prognostic factor of poor outcomes after OLT for fulminant hepatic failure [16]. Conversely, Leithead et al did not find an association between perioperative AKI or RRT and chronic kidney disease in patients who received transplants due to acute liver failure [17]. They proposed that the failure of perioperative renal dysfunction to impact long-term posttransplant renal outcomes in patients with acute liver failure could reflect the duration of renal impairment as the duration of renal dysfunction appears to be a key determinant of chronic renal impairment in patients who receive transplants due to chronic liver disease [10, 17].…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, Leithead et al did not find an association between perioperative AKI or RRT and chronic kidney disease in patients who received transplants due to acute liver failure [17]. They proposed that the failure of perioperative renal dysfunction to impact long-term posttransplant renal outcomes in patients with acute liver failure could reflect the duration of renal impairment as the duration of renal dysfunction appears to be a key determinant of chronic renal impairment in patients who receive transplants due to chronic liver disease [10, 17]. Nevertheless, it was observed that patients with fulminant hepatic failure and AKI rarely developed chronic kidney disease, which corroborates our finding that fulminant hepatic failure is a predictor of the need for RRT < 90 days after OLT [14].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Predictors of renal function recovery among patients undergoing renal replacement therapy following orthotopic liver transplantation

et al. 2017

View full text Add to dashboard Cite

Renal dysfunction frequently occurs during the periods preceding and following orthotopic liver transplantation (OLT), and in many cases, renal replacement therapy (RRT) is required. Information regarding the duration of RRT and the rate of kidney function recovery after OLT is crucial for transplant program management. We evaluated a sample of 155 stable patients undergoing post-intensive care hemodialysis (HD) from a patient population of 908 adults who underwent OLT. We investigated the average time to renal function recovery (duration of RRT required) and determined the risk factors for remaining on dialysis > 90 days after OLT. Log-rank tests were used for univariate analysis, and Cox proportional hazards models were used to identify factors associated with the risk of remaining on HD. The results of our analysis showed that of the 155 patients, 28% had pre-OLT diabetes mellitus, 21% had pre-OLT hypertension, and 40% had viral hepatitis. Among the patients, the median MELD (Model for End-Stage Liver Disease) score was 27 (interquartile range [IQR] 22-35). When they were listed for liver transplantation, 32% of the patients had serum creatinine (Scr) levels > 1.5 mg/dL or were on HD, and 50% had serum creatinine (Scr) levels > 1.5 mg/dL or were on HD at the time of OLT. Of the transplanted patients, 25% underwent pre-OLT intermittent HD, and 14% and 41% underwent continuous renal replacement therapy (CRRT) pre-OLT and post-OLT, respectively. At 90 days post-OLT, 118 (76%) patients had been taken off dialysis, and 16 (10%) patients had died while undergoing HD. The median recovery time of these post-OLT patients was 33 (IQR 27–39) days. In the multivariate analysis, fulminant hepatic failure as the cause of liver disease (p<0.001), the absence of pre-OLT hypertension (p = 0.016), a lower intraoperative fresh-frozen plasma (FFP) transfusion volume (p = 0.019) and not undergoing pre-OLT intermittent HD (p = 0.032) were associated with performing RRT for less than 90 days. Therefore, a high proportion of OLT patients showed improved renal function after OLT, and those who were diagnosed with fulminant hepatic failure, had no pre-OLT hypertension, received a lower transfused volume of intraoperative FFP and did not undergo pre-OLT intermittent HD had a higher probability of recovery.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Predictors of renal function recovery among patients undergoing renal replacement therapy following orthotopic liver transplantation

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Thus, there is minimal impact on long-term kidney function in patients requiring liver transplantation. 13,24 …”

Section: Discussionmentioning

confidence: 99%

Risk Factors and Outcomes of Acute Kidney Injury in Patients With Acute Liver Failure

Tujios

Hynan

Vázquez

et al. 2015

Clinical Gastroenterology and Hepatology

123

View full text Add to dashboard Cite

BACKGROUND & AIMS Patients with acute liver failure (ALF) frequently develop renal dysfunction, yet its overall incidence and outcomes have not been fully assessed. We investigated the incidence of acute kidney injury (AKI) among patients with ALF, using defined criteria to identify risk factors and to evaluate its effect on overall outcomes. METHODS We performed a retrospective review of data from 1604 patients enrolled in the Acute Liver Failure Study Group, from 1998 through 2010. Patients were classified by the Acute Kidney Injury Network criteria, as well as for etiology of liver failure (acetaminophen-based, ischemic, and all others). RESULTS Seventy percent of patients with ALF developed AKI, and 30% received renal replacement therapy (RRT). Patients with severe AKI had higher international normalized ratio values than those without renal dysfunction (P < .001), and a higher proportion had advanced-grade coma (coma grades 3 or 4; P < .001) or presented with hypotension requiring vasopressor therapy (P < .001). A greater proportion of patients with acetaminophen-induced ALF had severe kidney injury than of patients with other etiologies of ALF; 34% required RRT, compared with 25% of patients with ALF not associated with acetaminophen or ischemia (P < .002). Of the patients with ALF who were alive at 3 weeks after study entry, significantly fewer with AKI survived for 1 year. Although AKI reduced the overall survival time, more than 50% of patients with acetaminophen-associated or ischemic ALF survived without liver transplantation (even with RRT), compared with 19% of patients with ALF attribute to other causes (P < .001). Only 4% of patients requiring RRT became dependent on dialysis. CONCLUSIONS Based on a retrospective analysis of data from more than 1600 patients, AKI is common in patients with ALF and affects short- and long-term outcomes, but rarely results in chronic kidney disease. Acetaminophen-induced kidney injury is frequent, but patients have better outcomes than those with other forms of ALF.

show abstract

“…Pre-transplant renal dysfunction is the most important determinant of post-transplant chronic kidney disease; other factors include diabetes, hypertension, acute kidney injury pre-transplant and post-transplant immunosuppression. The presence of CKD in LTx recipients not only is important with respect to the need for renal replacement therapy and kidney transplantation but also increases cardiovascular risk dramatically [1,4,6].…”

Section: Discussionmentioning

confidence: 99%

“…Many factors contribute to renal dysfunction in liver transplant recipients, which is a common complication after liver transplantation (LTx) and negatively influences patient and graft survival [1][2][3]. Diabetes mellitus (DM), a common disease in LTx candidates, is an important risk factor leading to postoperative renal dysfunction [4].…”

Section: Introductionmentioning

confidence: 99%

Simultaneous pancreas and kidney transplantation for liver transplant recipients with diabetes and uremia

Tam

Zhang²,

Lin³

et al. 2015

Clinics and Research in Hepatology and Gastroenterology

View full text Add to dashboard Cite

Chronic Kidney Disease After Liver Transplantation for Acute Liver Failure Is Not Associated With Perioperative Renal Dysfunction

Cited by 24 publications

References 39 publications

Predictors of renal function recovery among patients undergoing renal replacement therapy following orthotopic liver transplantation

Predictors of renal function recovery among patients undergoing renal replacement therapy following orthotopic liver transplantation

Risk Factors and Outcomes of Acute Kidney Injury in Patients With Acute Liver Failure

Simultaneous pancreas and kidney transplantation for liver transplant recipients with diabetes and uremia

Contact Info

Product

Resources

About