Long‐term impact of dialysis‐requiring AKI during the perioperative period of liver transplantation on postdischarge outcomes

Abstract

Background Patients undergoing liver transplantation (LT) are prone to dialysis‐requiring acute kidney injury (AKI‐D). However, long‐term prognoses among them need further investigation, as overall survival after LT is improving. Methods A nationwide, population‐based cohort study was conducted using the data of Korean National Health Insurance System between 2006 and 2015. The patients who received dialysis during the perioperative period of LT were in the AKI‐D group, and the control group included those who did not undergo dialysis. Results Among the 6879 patients who underwent LT, 968 were in the AKI‐D group. All‐cause mortality [adjusted hazard ratio (HR): 1.52 (1.26‐1.83), P < 0.001], end‐stage renal disease (ESRD) progression [adjusted HR: 2.93 (2.34‐3.66), P < 0.001], and ICU readmission [adjusted HR: 1.70 (1.44‐2.01), P < 0.001] within and after 90 days from discharge were increased in the AKI‐D group. When analyzed among those who recovered from dialysis at discharge, overall outcomes were similar to those of the AKI‐D group, except the long‐term mortality. Conclusions AKI‐D during the perioperative period of LT was associated with worse mortality, ESRD progression, and ICU readmission risk. The results of renal‐recovered patients could indicate clinicians that achievement of dialysis independence is important to gain favorable long‐term postdischarge survival.

Pediatric length‐of‐stay index following liver transplantation

“…Several factors identified in this analysis have been previously shown in other literature to be significant for prolonged stay following pediatric liver transplant 16 . Specifically, one study illuminated the fact that hemodialysis prior to liver transplant is associated with worse mortality and increased ICU admission 18 . Furthermore, multiple studies found that ICU admission was associated with longer stays, higher mortality, and increased complications 14,19 .…”

“…Prolonged hospital stay following pediatric liver transplantation is a highly impactful metric which can be correlated to increased Specifically, one study illuminated the fact that hemodialysis prior to liver transplant is associated with worse mortality and increased ICU admission. 18 Furthermore, multiple studies found that ICU admission was associated with longer stays, higher mortality, and increased complications. 14,19 However, though discrete variables from this analysis have been identified as significant in other studies, there is scarce literature that specifically identifies multiple predictive variables and their effects on hospital stay following liver transplant.…”

Impact of Renal Replacement Therapy on Rejection among Liver Transplant Recipients

“…Similarly, prior studies have found heightened graft loss in recipients requiring RRT posttransplant characterized by greater mortality in this group. [8][9][10] Renal function at 1 year was significantly worse in the RRT group at all time points. This was anticipated as recipients in the RRT group had significantly worse renal function at baseline.…”

“…Both RRT and infection were linked with a heightened mortality risk, which has been observed in prior studies. 2,7,8 Although tacrolimus was delayed in an effort to reduce worsening renal dysfunction and infection risk, mycophenolate dosing and prednisone use were higher in the RRT group. Specifically, higher mycophenolate dosing was used by the end of the study, which may have been in response to greater BPAR observed in the RRT group.…”

Modelling kidney outcomes based on MELD eras - impact of MELD score in renal endpoints after liver transplantation

“…Few studies report time disparities in kidney disfunction after LT based on MELD score-based liver allocation policy implementation. Lee et al failed to demonstrate differences between three ages (1996–2000 / 2001–2005 / 2006–2008) in identifying chronic kidney disease in a cohort of 431 patients after 6 months of LT [ 21 ]. Leithead et al shows increase in incidence of AKI over 3 study periods (2000–2003, 2004–2007 and 2008–2011) even after adjusted for confounding variables [ 22 ].…”