Rapid deterioration of pre-transplant kidney function requiring dialysis is a prognostic factor in liver transplant alone.
Nagai S, Safwan M, Collins K, Rizzari M, Moonka D, Patel A, Brown K, Yoshida A, and Abouljoud M. Rapid deterioration of pre-transplant kidney function requiring dialysis is a prognostic factor in liver transplant alone. Am J Transplant 2017; 17:776.
Am J Transplant
Aim: Etiologies of acute kidney injury before liver transplant extend beyond hepatorenal syndrome (ie infection, gastrointestinal bleeding) and therefore, may not be resolved by liver transplantation. We hypothesized that rapid deterioration of kidney function immediately before transplant would impact outcome significantly. The aim of this study was to review the safety of liver transplant alone (LTA) in cases of rapid deterioration of kidney function requiring dialysis by comparing outcomes in liver transplant alone (LTA) and simultaneous liver-kidney transplant (SLK). Methods: We retrospectively reviewed of 532 primary deceased donor LT patients from 2009 to 2015. SLK patients (n=44) were compared to patients who required pre-transplant dialysis. The latter group was categorized according to the duration of low GFR (Group 1: GFR<30mL/min for 3 weeks or less [rapid deterioration group, n=24], Group 2: GFR<30mL/min over 3 weeks [sustained injury group, n=16]). Results: Median durations of low GFR (<60mL/min and <30mL/min) and pretransplant dialysis were shorter in Group 1 than Group 2 (23, 13, and 7 days vs. 51, 33, and 18 days). Group 1 showed significantly worse one-year survival than the SLK group (66% vs. 93%, P=0.01), whereas it was comparable between the Group 2 and SLK group (88% vs. 93%, P=0.52). Post-transplant dialysis was required in 100% and 87% of patients in Groups 1 and 2, respectively. Seven patients in Group 1 died in the first year, five of whom remained on dialysis until their deaths. In Group 2, one patient who recovered kidney function died of PTLD on POD 220. While GFR at 12 months after transplant was significant better in the SLK group, it was comparable between Groups 1 and 2, (63, 47, and 45mL/min in the SLK, Groups 1, and 2, respectively, P=0.03). Graft survival after one year was similar among these 3 groups (P=1.0). Conclusion: Rapid deterioration of kidney function before LTA, rather than sustained kidney injury, is more likely lead to persistent renal failure and increase one-year mortality. In patients with rapid renal dysfunction; deferring LTA until etiology of renal dysfunction can be clarified may be warranted. Further investigation is needed determine if SLK improves early outcomes of this population.