INCREASING RENAL INSUFFICIENCY AFTER LIVER TRANSPLANT: AN ANALYSIS OF UNOS REGISTRY

Document Type

Conference Proceeding

Publication Date

10-1-2022

Publication Title

Hepatology

Abstract

Background: Renal insufficiency (RI) remains a major source of morbidity after liver transplant (LT). Recent years have seen an increase in metabolic syndrome and non-alcoholic steatohepatitis (NASH) in LT patients. The current study uses the United Network for Organ Sharing (UNOS) database to evaluate trends in RI after liver transplant over time. Methods: Using UNOS data, we analyzed adult LT patients undergoing initial, deceased donor, liver alone transplants between 2008-2020 who survived at least six months. Patients were divided into four groups by era: Era 1 (2008-2011), Era 2 (2012-2015), Era 3 (2016-2018), Era 4 (2019-Oct 1, 2020). Patients were evaluated for RI one year after transplant using the glomerular filtration rate (GFR). To avoid survival bias, patients who died between 6 and 12 months post-LT were classified by their month 6 GFR. A multivariate analysis was performed to determine patient and donor variables associated with RI after liver transplant. Results: 67,741 LT patients met inclusion criteria and represent the study population: 18,500 in Era 1, 19,556 in Era 2, 17,993 in Era 3 and 11,692 in Era 4. Patients who had a GFR < 30 were stable across Eras 1-3 but increased markedly in Era 4 (8.1%, 8.2%, 8.3% and 13.6% respectively: P<0.001). Patients with GFR > 60 declined from from 50.35%, 49.8%, 48.31% to 43.71% (P<0.001). Patients in the most recent era were more likely to have NASH (7.1% to 19.2%) or alcoholic liver disease (12.8% to 31.9%) with P value <0.001. Across eras, recipients were more likely to be women (32.6% to 35.0%: P<0.001), Hispanic (13.1% to 16.2%: P<0.001), diabetic (24.2% to 28.4%: P<0.001) and on dialysis at transplant (7.5% to 12.1%). Donor livers were likely to be from donation after circulatory death (DCD) patients (5.2% to 10.1%: P<0.001) and from regional (21.2 to 30.4) and national share (4.4 to 15.0: P<0.001). On multivariate analysis, factors associated with GFR < 30 include female gender (HR 1.77: {95% C1 1.62-1.94}: P<0.001), diabetes (HR 1.80: {95% C1 1.64-1.98}: P<0.001), dialysis prior to transplant (HR 2.36: {95% C1 2.07-2.68}: P<0.001), recipient diagnosis of NASH (HR 1.77: {95% C1 1.51-2.08}: P<0.001) or ALD (HR 1.25: {95% C1 1.08-1.46}: P=0.003). Donor variables associated with GFR <30 include black race ((HR 1.29: {95% C1 1.16-1.44}: P<0.001) and national share (HR 1.97: {95% C1 1.70-2.29: P<0.001) but not use of a donation after circulatory death (DCD) liver. Conclusion: There is a significant increase in RI in the most recent era associated with an increase in patients with diabetes, NASH, ALD and dialysis at transplant. There was no association between RI and use of DCD livers. The findings raise concerns about intermediate outcomes after LT with implications for donor and patient selection and the need for less nephrotoxic immunosuppressive regimens.

Volume

76

First Page

S535

Last Page

S536

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