Impact of preoperative chronic renal failure on liver transplantation: a population-based cohort study

Abstract

Purpose: The purpose of this study was to assess whether preoperative chronic renal failure (CRF) affects the rates of postoperative complications and survival after liver transplantation. Methods: This population-based retrospective cohort study included 2,931 recipients of liver transplantation performed between 1998 and 2012, enrolled from the Taiwan National Health Insurance Research Database. Patients were divided into two groups, based on the presence or absence of preoperative CRF. Results:The overall estimated survival rate of liver transplantation recipients (LTRs) with preoperative CRF was significantly lower than that of patients without preoperative CRF (P=0.0085). There was no significant difference between the groups in terms of duration of intensive care unit stay, total hospital stay, bacteremia, postoperative bleeding, and pneumonia during hospitalization. Long-term adverse effects, including cerebrovascular disease and coronary heart disease, were not different between patients with versus without CRF. Conclusion: These findings suggest that LTRs with preoperative CRF have a higher rate of mortality.

A meta‐analysis on the prevalence of chronic kidney disease in liver transplant candidates and its associated risk factors and outcomes

“…The population samples consisted of liver transplant recipients identified by the respective institutions. They originated from nine different countries with five from USA [5,14,18,34,35] three from Japan Chronic kidney disease in liver transplant candidates [2,9,36] one from Korea [37], one from Taiwan [6], one from Germany [17], one from Brazil [38], one from Turkey [39], one from Italy [40], and one from Switzerland [13]. Mean age of CKD patients ranged from 46.8 years to 58.7 years, while mean age of non-CKD patients ranged from 46.3 years to 56.3 years.…”

“…Advancements in the field of liver transplantation (LT) have yielded drastic improvements in short-term graft and patient survival outcomes [1,2]. However, the development of chronic kidney disease (CKD) before liver transplant persists as a complicated, multifaceted issue leading to a multitude of adverse outcomes including inferior graft survival, increased infection, increased health care cost, and longer duration of stay [3][4][5][6][7]. Patients with pre-LT CKD suffer increased intraoperative blood loss and haemostatic abnormalities, bearing a 15% increased risk of post-operative mortality [8,9].…”

“…While CKD after liver transplant has been discussed extensively [6], studies describing renal dysfunction in the setting of liver disease before transplant are scarce [2]. Hence, this review aims to synthesize available evidence concerning the prevalence and post-operative outcomes of patients with CKD pre-LT using definition of CKD as per Kidney Disease Improving Global Outcomes (KDIGO) 2012 guidelines.…”