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Observational Study
. 2013 Jul;8(7):1135-42.
doi: 10.2215/CJN.09600912. Epub 2013 Feb 28.

Short-term pretransplant renal replacement therapy and renal nonrecovery after liver transplantation alone

Pratima Sharma  1 , Nathan P Goodrich, Min Zhang, Mary K Guidinger, Douglas E Schaubel, Robert M Merion
Affiliations
Observational Study

Short-term pretransplant renal replacement therapy and renal nonrecovery after liver transplantation alone

Pratima Sharma et al. Clin J Am Soc Nephrol. 2013 Jul.

Abstract

Background and objectives: Candidates with AKI including hepatorenal syndrome often recover renal function after successful liver transplantation (LT). This study examined the incidence and risk factors associated with renal nonrecovery within 6 months of LT alone among those receiving acute renal replacement therapy (RRT) before LT.

Design, setting, participants, & measurements: Scientific Registry of Transplant Recipients data were linked with Centers for Medicare and Medicaid Services ESRD data for 2112 adult deceased-donor LT-alone recipients who received acute RRT for ≤90 days before LT (February 28, 2002 to August 31, 2010). Primary outcome was renal nonrecovery (post-LT ESRD), defined as transition to chronic dialysis or waitlisting or receipt of kidney transplant within 6 months of LT. Cumulative incidence of renal nonrecovery was calculated using competing risk analysis. Cox regression identified recipient and donor predictors of renal nonrecovery.

Results: The cumulative incidence of renal nonrecovery after LT alone among those receiving the pre-LT acute RRT was 8.9%. Adjusted renal nonrecovery risk increased by 3.6% per day of pre-LT RRT (P<0.001). Age at LT per 5 years (P=0.02), previous-LT (P=0.01), and pre-LT diabetes (P<0.001) were significant risk factors of renal nonrecovery. Twenty-one percent of recipients died within 6 months of LT. Duration of pretransplant RRT did not predict 6-month post-transplant mortality.

Conclusions: Among recipients on acute RRT before LT who survived after LT alone, the majority recovered their renal function within 6 months of LT. Longer pre-LT RRT duration, advanced age, diabetes, and re-LT were significantly associated with increased risk of renal nonrecovery.

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Figures

Figure 1.
Figure 1.
Selection of cohort.
Figure 2.
Figure 2.
Distribution of the duration of pre-LT RRT. LT, liver transplantation; RRT, renal replacement therapy.
Figure 3.
Figure 3.
Cumulative incidence of post-LT ESRD (renal nonrecovery) within 6 months of LT among patients on acute RRT at LT, stratified by the tertiles of duration of pre-LT RRT. LT, liver transplantation; RRT, renal replacement therapy.
Figure 4.
Figure 4.
Cumulative incidence of post-LT ESRD (renal nonrecovery) and death after 6 months of LT among patients with stage 4 CKD at 6 months after LT alone. LT, liver transplantation.
See this image and copyright information in PMC

References

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