Kidney Week

Abstract: FR-PO1173

Longitudinal Kidney Function After Liver Transplantation in Patients with Acute-on-Chronic Liver Failure

Session Information

• Transplantation: Clinical - Post-Transplant Complications
  November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1902 Transplantation: Clinical

Authors

• Yazawa, Masahiko, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Masahiko Yazawa,

• Karri, Saradasri, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Saradasri Karri,

• Podila, Pradeep S b, Methodist Le Bonheur Healthcare, Memphis, Tennessee, United States

Pradeep S b Podila,

• Agbim, Uchenna, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Uchenna Agbim,

• Maluf, Daniel, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Daniel Maluf,

• Eason, James D., University of Tennessee Health Science Center, Memphis, Tennessee, United States

James D. Eason,

• Satapathy, Sanjaya K., Northshore University Hospital/Northwell Health, Manhasset, New York, United States

Sanjaya K. Satapathy,

• Molnar, Miklos Zsolt, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Miklos Zsolt Molnar,

Group or Team Name

• METEOR (MEthodist Transplant EpidemiOlogy Research) Group

Background

Acute on Chronic Liver Failure (ACLF) is a syndrome defined as acute decompensation on pre-existing chronic liver disease (cirrhosis) caused by hepatic or extra-hepatic insights with several organ failures including acute kidney injury and associated with worse prognosis unless undergoing liver transplantation (LT). However, it has not been well known whether ACLF affects mid- and long-term kidney function after transplantation.

Methods

From 687 eligible LT recipients, 413 patients who had the data of serum creatinine at 3 months after LT (baseline) has been included, in this single-center, retrospective cohort study. Association of ACLF and estimated glomerular filtration rate (eGFR) at baseline and 12 months, also eGFR slope after baseline assessed by mixed effect model has been assessed.

Results

Fifty-nine patients (14.3%) was assigned to ACLF group. ACLF group was significantly younger, higher prevalence of alcoholic hepatitis, higher MELD score, and lower mean eGFR at the time of LT compared to non-ACLF group. The eGFR recovered toward to baseline then stabilized through 12 months after LT in ACLF group and eGFR decreased toward to baseline then stabilized through 12 months after LT in non-ACLF group. However, eGFR at baseline and 12 months in ACLF group was still significantly lower than that in non-ACLF group (53.6±29.1 and 62.3±25.2 ml/min/1.73m² in ACLF group and 65.4±26.2 and 70.5±22.6 ml/min/1.73m² in non-ACLF group) (Figure). The eGFR slope in non-ACLF group was decreasing (-2.58 ml/min/1.73m²/year, 95%CI: -4.79 to -0.38); however, the eGFR slope in ACLF group did not have significant trajectory (0.93 ml/min/1.73m²/year, 95%CI: -6.08 to 7.94) during observational period. These slopes were not statistically different between two groups (p=0.431).

Conclusion

The mid- and long-term eGFR in ACLF group would be corresponded to deteriorated eGFR before LT and would not recover to the same level of non-ACLF group.