Incidence and outcomes of immediate post-operative dialysis in liver transplantation.
Nagai S, Safwan M, Collins K, Rizzari M, Yoshida A, Abouljoud MS. Incidence and outcomes of immediate post-operative dialysis in liver transplantation.. Am J Transplant 2017; 17:774.
Am J Transplant
Aim: Although kidney dysfunction secondary to hepatorenal syndrome is expected to recover with liver transplant alone (LTA), patients with pre-transplant marginal kidney function may be more susceptible to intra-operative stresses which cause further kidney injury. The aim of this study was to evaluate incidence and outcomes of immediate post-transplant dialysis in liver transplant. Methods: We retrospectively reviewed records of 44 simultaneous liver-kidney transplant patients and 204 LTA patients with pre-transplant marginal kidney function (GFR<60mL/min) from 2009 to 2015. First, we identified the incidence of immediate post-transplant dialysis in all patients and assessed for early liver allograft dysfunction (Olthoff criteria) and liver graft survival. Second, risk factors for post-transplant dialysis were analyzed in LTA patients. Results: Of 44 SLK patients, 12 (27%) needed post-transplant dialysis (median 10.5 days, interquartile range [IQR] 6-28 days). Of 204 LTA patients, 42 were on dialysis pre-transplant, of whom 38 (90%) had persistent dialysis requirement post-transplant (median 9.5 days, IQR 4-31 days). Of the 162 who were not on dialysis pre-transplant, 22 (14%) had dialysis requirement post-transplant (median 4 days, IQR 2-22 days). Patients who required post-transplant dialysis showed significantly worse graft survival compared with those without post-transplant dialysis (P=0.003). Posttransplant dialysis requirement was significantly associated with early liver allograft dysfunction (P=0.03). Pre-transplant dialysis was significantly associated with need for post-transplant dialysis (P<0.001). In LTA patients without pre-transplant dialysis, the following risk factors for post-transplant dialysis were identified as significant: cold ischemia time>350min (P=0.03), warm ischemia time>40min (P=0.02), red blood cell transfusion>10 units (P=0.004), and pre-op GFR<30mL/min (P=0.003). Large volume of red blood cell transfusion and pre-op GFR<30mL/min remained independent risk factors on multivariate analysis. Conclusion: The adverse impact of immediate post-transplant dialysis on early liver allograft function as well as graft survival should be recognized. While posttransplant dialysis is frequently unavoidable in patients requiring pre-transplant dialysis, efforts to reduce intra-op transfusions and shortening ischemia time may decrease risk of post-transplant dialysis in LTA patients with marginal kidney function.