The changing impact of pre-liver transplant renal dysfunction on post-transplant survival: results of 2 decades from a single center

Hani M. Wadei, C. Burcin Taner, Andrew P. Keaveny, Martin L. Mai, David O. Hodge, Launia J. White, Denis M. Harnois, Shennen A. Mao, Tambi Jarmi, Kristopher P. Croome

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction and Objectives: Renal dysfunction before liver transplantation (LT) is associated with higher post-LT mortality. We aimed to study if this association still persisted in the contemporary transplant era. Materials and Methods: We retrospectively reviewed data on 2871 primary LT performed at our center from 1998 to 2018. All patients were listed for LT alone and were not considered to be simultaneous liver–kidney (SLK) transplant candidates. SLK recipients and those with previous LT were excluded. Patients were grouped into 4 eras: era-1 (1998–2002, n = 488), era-2 (2003–2007, n = 889), era-3 (2008–2012, n = 703) and era-4 (2013–2018, n = 791). Pre-LT renal dysfunction was defined as creatinine (Cr) >1.5 mg/dl or on dialysis at LT. The effect of pre-LT renal dysfunction on post-LT patient survival in each era was examined using Kaplan Meier estimates and univariate and multivariate Cox proportional hazard analyses. Results: Pre-LT renal dysfunction was present in 594 (20%) recipients. Compared to patients in era-1, patients in era-4 had higher Cr, lower eGFR and were more likely to be on dialysis at LT (P < 0.001). Pre-LT renal dysfunction was associated with worse 1, 3 and 5-year survival in era-1 and era-2 (P < 0.005) but not in era-3 or era-4 (P = 0.13 and P = 0.08, respectively). Multivariate analysis demonstrated the lack of independent effect of pre-LT renal dysfunction on post-LT mortality in era-3 and era-4. A separate analysis using eGFR <60 mL/min/1.73 m2 at LT to define renal dysfunction showed similar results. Conclusions: Pre-LT renal dysfunction had less impact on post-LT survival in the contemporary transplant era.

Original languageEnglish (US)
Article number100317
JournalAnnals of hepatology
Volume24
DOIs
StatePublished - Sep 1 2021

Keywords

  • Liver transplant outcome
  • Pre-LT renal dysfunction

ASJC Scopus subject areas

  • Hepatology

Fingerprint Dive into the research topics of 'The changing impact of pre-liver transplant renal dysfunction on post-transplant survival: results of 2 decades from a single center'. Together they form a unique fingerprint.

Cite this