Beneficial and harmful effects of nonselective beta blockade on acute kidney injury in liver transplant candidates

Sang Gyune Kim, Joseph J. Larson, Ji Sung Lee, Terry M Therneau, W. Ray Kim

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Nonselective beta-blockers (NSBBs) have played an important role in the prevention of portal hypertensive bleeding in patients with cirrhosis. However, recent studies have suggested that NSBBs may be harmful in some patients with end-stage liver disease. The purpose of this article is to evaluate the association between use of NSBB and the incidence of acute kidney injury (AKI). We conducted a nested case-control study in a cohort of liver transplant wait-list registrants. Each patient with AKI was matched to a control by the Model for End-Stage Liver Disease–Na score, age, serum creatinine, and follow-up duration. Out of a total of 2361 wait-list registrants, 205 patients developed AKI after a median follow-up duration of 18.2 months. When compared with matched controls, ascites (79.0% versus 51.7%) and non-Caucasian race (16.6% versus 7.8%) were more common among the cases. The frequency of NSBB use was higher among the cases than controls, albeit insignificantly (45.9% versus 37.1%; P = 0.08). In multivariate analyses, the impact of nonselective beta blockade on the development of AKI was dependent on the presence of ascites: nonselective beta blockade in patients with ascites significantly increased the risk of AKI (hazard ratio [HR], 3.31; 95% confidence interval [CI], 1.57-6.95), whereas in patients without ascites, NSBB use reduced it (HR, 0.19; 95% CI, 0.06-0.60). Potential benefits and harms of a NSBB in terms of AKI depend on the presence of ascites in liver transplant candidates. NSBB therapy in patients with cirrhosis may need to be individualized. Liver Transplantation 23 733–740 2017 AASLD.

Original languageEnglish (US)
Pages (from-to)733-740
Number of pages8
JournalLiver Transplantation
Volume23
Issue number6
DOIs
StatePublished - Jun 1 2017

Fingerprint

Acute Kidney Injury
Ascites
Transplants
Liver
Fibrosis
Confidence Intervals
End Stage Liver Disease
Liver Transplantation
Case-Control Studies
Creatinine
Multivariate Analysis
Hemorrhage
Incidence
Serum

ASJC Scopus subject areas

  • Surgery
  • Hepatology
  • Transplantation

Cite this

Beneficial and harmful effects of nonselective beta blockade on acute kidney injury in liver transplant candidates. / Kim, Sang Gyune; Larson, Joseph J.; Lee, Ji Sung; Therneau, Terry M; Kim, W. Ray.

In: Liver Transplantation, Vol. 23, No. 6, 01.06.2017, p. 733-740.

Research output: Contribution to journalArticle

Kim, Sang Gyune ; Larson, Joseph J. ; Lee, Ji Sung ; Therneau, Terry M ; Kim, W. Ray. / Beneficial and harmful effects of nonselective beta blockade on acute kidney injury in liver transplant candidates. In: Liver Transplantation. 2017 ; Vol. 23, No. 6. pp. 733-740.
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