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Abstract: PO2433

Immediate Allograft Function After Liver Transplant (LT) Modifies the Effect of Pre-LT Renal Dysfunction (RD) on Post-LT Survival

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Wadei, Hani, Mayo Clinic's Campus in Florida, Jacksonville, Florida, United States
  • Mao, Shennen, Mayo Clinic's Campus in Florida, Jacksonville, Florida, United States
  • Mai, Martin L., Mayo Clinic's Campus in Florida, Jacksonville, Florida, United States
  • Aslam, Nabeel, Mayo Clinic's Campus in Florida, Jacksonville, Florida, United States
  • Croome, Kristopher, Mayo Clinic's Campus in Florida, Jacksonville, Florida, United States
Background

Pre-LT RD is associated with higher post-LT mortality. It is unclear if immediate liver allograft function modifies this risk.

Methods

We retrospectively reviewed data on 2,856 primary LT performed in our center from 1998 to 2018. Pre-LT RD was defined as Cr >1.5 mg/dl or on dialysis at LT. Immediate liver allograft function was defined using the validated early allograft dysfunction (EAD) criteria (bilirubin≥10 mg/dl, INR ≥1.6 or ALT/AST ≥2000IU/mL on POD 7). Pre-LT RD was present in 591(21%), of these 429 patients had Cr >1.5 and 165 were on dialysis. EAD developed in 784 (27%).The cohort was divided into 4 groups according to pre-LT RD and EAD. Group 1 (n=1,617): No RD and no EAD, Group 2 (n=643): No RD but had EAD, Group 3 (n=451): had RD and no EAD, Group 4 (n=140): had both RD and EAD. The unadjusted and adjusted post-LT survival was compared between the 4 groups.

Results

Results are presented in Figure 1. Group 1 had the best outcome with 1,3 and 5 year survival of 95%, 89% and 82%, respectively, and group 4 had the worst outcome with 1, 3 and 5 year survival of 79%, 70% and 60%, respectively,P <0.0001. Group 2 and 3 had intermediate and comparable (P=0.5 between group 2&3) outcomes. Survival was better in group 2&3 compared to those in group 4 (P<0.001) but was worse than group 1 (P=0.02). After adjusting for recipient age, female gender, DM, MELD score, cause of ESLD and DRI, group 4 had the highest risk of death (aHR 2.33, CI:1.69-3.21, P<0.001). Patients in group 2 (aHR 1.16, CI:0.95-1.41, P=0.1) and group 3 (aHR 1.23; CI: 0.96-1.58, P=0.09) had comparable adjusted risk of death to group 1 patients.

Conclusion

LT recipients with pre-LT RD who enjoy immediate liver allograft function have comparable adjusted survival to those with normal renal function at LT. Our results indicate that livers at higher risk of EAD should be avoided in LT recipients with RD.

Kaplan-Meier analysis of post-LT patient survival according to pre-LT RD and post-LT EAD