Survival of liver transplant candidates with acute renal failure receiving renal replacement therapy

Abstract

RRT is justifiable for liver transplant candidates with ARF. Though mortality was high, a substantial percentage (31%) of patients survived to liver transplant. Postoperative mortality is increased compared with all other liver transplant recipients, but is acceptable considering the near-universal mortality without transplantation.

Kidney and Pancreas Transplantation in the United States, 1996–2005

“…These candidates receive priority for donor kidneys over kidney-alone candidates in the allocation algorithm. Since the indications for liver-kidney transplantation are not well defined, there is considerable debate about the necessity of diverting approximately 3.4% of transplanted DD kidneys to liver-kidney recipients, and about whether some of these candidates without fixed renal disease might not experience recovery of native renal function (13,14). Efforts to more clearly define the indications for liver-kidney are limited by the lack of large single-center experience, and by insufficient registry data regarding duration of pretransplant dialysis and cause of renal disease in liver and liver-kidney candidates.…”

Hepatorenal Syndrome

“…Types 1 and 2 HRS are the cause of ARF in 20 and 6.6% of cases, respectively (19). Similarly, in the study by Wong et al (80), ATN and HRS were the most common causes of ARF in 102 patients who had cirrhosis, were on renal replacement therapy (RRT), and were waiting for liver transplantation; 48% of those had HRS.…”

“…From 1996 to 1999, a total of 19 patients also received preoperative RRT: One HD and 18 CRRT; the 1-yr patient survival in this group was lower, at 73.6%, possibly reflecting the more serious nature of their illness. Another recent study of 102 patients who had cirrhosis and ARF, 48% of them with HRS, and were awaiting a liver transplant and receiving RRT showed increased mortality for those who were maintained on CRRT compared with HD (78 versus 50%; P ϭ 0.02) (80). Nevertheless, those who received CRRT had greater severity of illness and lower BP than those who received HD.…”

“…Nevertheless, those who received CRRT had greater severity of illness and lower BP than those who received HD. The authors concluded that RRT still is justifiable in HRS as the high mortality rate is comparable to similarly ill patients who have ARF without cirrhosis (80). Although the best modality of RRT in HRS is not well defined, patients who have HRS and receive RRT can be treated with either HD or CRRT before transplantation with similar outcomes.…”

Old Immunosuppressive Agents: Newer Approach in liver Transplant Recipients to Achieve Rejection Free and Nephron Preserving Protocol

“…Patients with higher MELD scores invariably have a degree of renal dysfunction or even renal failure requiring renal replacement therapy mainly for hepatorenal syndrome type I or type II. Also, up to 20% of patients who were not on dialysis pre-transplant may require dialysis in post-transplant period [2,3]. Various immunosuppressive approaches have been cited with use of antibody preparation in group of patient with pre-existing renal dysfunction including IL-2 inhibitors and Thymoglobulin [4].…”