Abstract: TH-PO054
Pre-Liver Transplant Acute Kidney Disease Highlights Impaired Renal Function Recovery Phase
Session Information
- AKI: Liver Disease, Nephrotoxicity, Novel Therapeutics
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Lee, Jacqueline, Cedars-Sinai Medical Center, Los Angeles, California, United States
- Huang, Edmund, Cedars-Sinai Medical Center, Los Angeles, California, United States
- Kumar, Sanjeev, Cedars-Sinai Medical Center, Los Angeles, California, United States
Background
Acute kidney disease (AKD), the phase between acute kidney injury (AKI) and chronic kidney disease (CKD), represents a crucial time window for initiation of therapies that may significantly augment renal function recovery. Herein, we aim to study the impact of duration of AKI in patients with decompensated cirrhosis on subsequent renal function recovery post-liver transplantation.
Methods
This is a single-center, retrospective study of adults who underwent single-organ, orthotopic liver transplant (OLT) from Jan 2015 to Dec 2021. AKD was defined as persistence of AKI for greater than a week but up to 90 days. The study cohort was classified by pre-transplant AKI duration and renal replacement therapy (RRT) status into four groups: normal kidney function, AKI requiring RRT within 7 days of onset (AKI_RRT), AKD without RRT (AKD_noRRT), and AKD with RRT (AKD_RRT). Renal function was compared with serial measurements of eGFR before and after OLT.
Results
Approximately half of the patients required RRT prior to OLT (81/170, 47.6%): 24% (41/170) required RRT within 7 days of AKI and other 23.7% (40/170) during the AKD phase. Only 6.5% (11/170) underwent OLT with AKD but without RRT. The remaining cohort had normal renal function (78/170, 45.8%). Patients who were commenced on RRT during the AKD phase had significantly lower eGFRs at 3 months and 1 year compared to AKI_RRT group [AKD_RRT vs. AKI_RRT; 41.6 ml/min vs. 56.6 ml/min, p < 0.05 (3 months); and 49.7 ml/min vs. 59.2 ml/min, p < 0.05 (1 year)]. No significant deterioration of eGFR was found in the normal function group.
Conclusion
Our study findings suggest AKD is associated with significantly reduced renal function recovery at 1-year post-liver transplantation. Our study demarcates the critical phase of AKI associated with maximal renal function recovery in cirrhotic patients for OLT and inform when best to initiate therapies that are linked with renal function recovery.
Post-liver transplant eGFR Trajectories
| Variable | Normal Creatinine Function | AKI_RRT | AKD_noRRT | AKD_RRT | p-value |
| Participants - n | 78 | 41 | 11 | 40 | |
| eGFR at transplant | 86.8 ± 46.9 | 15.7 ± 17.7 | 51.2 ± 27.8 | 15.6 ± 15.2 | <0.05 |
| At 3 months* | 77.3 ± 42.7 | 56.6 ± 27.3 | 52.3 ± 15.7 | 41.6 ± 25.9 | <0.05 |
| At 1 year** | 77.2 ± 41.5 | 59.2 ± 29.6 | 55.3 ± 22.6 | 49.7 ± 29.2 | <0.05 |
*missing values - 3 for 3 months (defined as -2 weeks to +6 weeks of 3 months) ** missing values - 22 for 1 year (± 4 weeks from 1 year mark)