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Master of Public Health

Kidney injury and status 1 liver transplantation: outcomes, kidney function, and listing for kidney transplantation

AUTHORS

Cloonan DJ , Cloonan MR , Westphal SG , Dageforde LA , Merani S , . Clinical transplantation. 2023 2 1; (). e14921

ABSTRACT

BACKGROUND: Effects of kidney injury at the time of liver transplantation (LT) for acute liver failure (ALF) remain poorly described. We hypothesized that patients with ALF and kidney injury (KI) who undergo LT have persistent post-transplant KI, inferior survival, and increased rate of kidney transplantation (KT).

METHODS: The US Scientific Registry of Transplant Recipients database was queried for patients transplanted with Status 1 listing for LT between 2002-2021. KI was defined as estimated glomerular filtration rate (eGFR) ≤ 30 mL/min/1.73 m or dialysis in the week prior to LT. Outcomes evaluated were post-LT eGFR, listing for subsequent KT, and overall survival (OS) after LT.

RESULTS: 2984 patients underwent LT for ALF with 1241 (41.6%) having KI. KI patients had lower eGFR at 6 months post LT (57.8 vs 68.7, p<0.001) that persisted out to 5 years (59.9 vs 69.7, p<0.001). KI patients were more likely to be listed for KT (4.3% vs 1.9%, p<0.001) and undergo listing sooner after LT (0.8 vs 3.7 years, p<0.001). Patients without KI had higher adjusted post-transplant OS compared to those with KI (HR 0.75, p<0.001).

CONCLUSION: KI in the setting of ALF portends a worse prognosis for both kidney recovery and OS. This article is protected by copyright. All rights reserved.

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