Minimal Improvement in Glomerular Filtration Rate in the First Year After Liver Transplantation

Mangus, Richard S.; Lutz, Andrew J.; Fridell, Jonathan A.; Kubal, Chandrashekhar A.; Bush, Weston J.; Tector, A. Joseph

doi:10.1097/tp.0000000000000668

Cited by 12 publications

(11 citation statements)

References 23 publications

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“…These findings also support the new criteria in that increased use of SLK could help to avoid the poor outcome associated with persistent kidney dysfunction after LTA. In fact, a previous research study reported that kidney function had not fully recovered 1 year after LTA, which concurred with our findings . On the other hand, post‐transplant eGFR gradually declined in the SLK group, which was probably associated with nephrotoxicity because of calcineurin inhibitor.…”

Section: Discussionsupporting

confidence: 91%

Liver alone or simultaneous liver-kidney transplant? Pretransplant chronic kidney disease and post-transplant outcome - a retrospective study

et al. 2018

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The new Organ Procurement and Transplant Network/United Organ Sharing Network (OPTN/UNOS) simultaneous liver-kidney transplant (SLK) policy has been implemented. The aim of this study was to review liver transplant outcomes utilizing the new SLK policy. Liver transplant alone (LTA) and SLK patients between 2009 and 2015 were reviewed. Graft survival and post-transplant kidney function were investigated among LTA patients meeting the chronic kidney disease (CKD) criteria of the new policy (LTA-CKD group). To validate our findings, we reviewed and applied our analysis to the OPTN/UNOS registry. A total of 535 patients were eligible from our series. The LTA-CKD group (n = 27) showed worse 1-year graft survival, compared with the SLK group (n = 44), but not significant (81% vs. 93%, P = 0.15). The LTA-CKD group significantly increased a risk of post-transplant dialysis (odds ratio = 5.59 [95% CI = 1.27-24.7], P = 0.02 [Ref. normal kidney function]). Post-transplant dialysis was an independent risk factor for graft loss (hazard ratio = 7.25, 95% CI = 3.3-15.91, P < 0.001 [Ref. SLK]). In the validation analysis based on the OPTN/UNOS registry, the hazard of 1-year-graft loss in the LTA-CKD group (n = 751) was 34.8% higher than the SLK group (n = 2856) (hazard ratio = 1.348, 95% CI = 1.157-1.572, P < 0.001). Indicating SLK for patients who meet the CKD criteria may significantly improve transplant outcomes.

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Section: Discussionsupporting

confidence: 91%

Liver alone or simultaneous liver-kidney transplant? Pretransplant chronic kidney disease and post-transplant outcome - a retrospective study

et al. 2018

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“…Moreover, it could not be determined whether induction IS reduced the severity of rejection episodes because rejection grade is not available from UNOS data. Due to significant missing data, changes in post‐LT renal function beyond 1 year were not explored, though prior research indicates that little change occurs after the first year post‐LT . In addition, dialysis status after LT was not available, limiting the interpretation of changes in eGFR post‐LT.…”

Section: Discussionmentioning

confidence: 99%

The use of induction therapy in liver transplantation is highly variable and is associated with posttransplant outcomes

Bittermann

Hubbard

Goldberg

2019

American Journal of Transplantation

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The use of induction immunosuppression in liver transplantation (LT) remains controversial. This was a retrospective cohort study of adult, first‐time liver‐alone recipients (N = 69 349) at 114 US centers between 2005 and 2018 using data from the United Network for Organ Sharing. The comparative effectiveness of nondepleting and depleting induction (NDI and DI) was assessed. Overall, 27% of recipients received induction with 65.7% of the variance in the receipt of induction being attributed to transplant center alone. NDI and DI were associated with a lower risk of death/graft failure compared to no induction (adjusted hazard ratio 0.90 [95% confidence interval (CI): 0.86‐0.95] and 0.91 [95% CI: 0.85‐0.97], respectively; P < .001). In nondialysis recipients at the mean transplant estimated glomerular filtration rate (eGFR), NDI was associated with an adjusted gain in eGFR by 6 months of +3.8 mL/min per 1.73 m2 and DI of +3.33 mL/min per 1.73 m2 compared to no induction (P < .001). Recipients with lower eGFR at LT had greater predicted improvement in eGFR (interaction P < .001). Only NDI was associated with a reduced risk of acute rejection in the first year post‐LT (odds ratio 0.87, 95% CI: 0.8‐0.94). Significant variability in induction practices exists, with center being a major determinant. The absolute incremental benefits of NDI and DI over no induction were small.

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“…Additionally, the kidney allograft is compromised by significant hepatic reperfusion injury and elevated bilirubin levels, both of which damage renal tubules, creating acute tubular necrosis. This phenomenon results in a decrease of 15% to 20% of glomerular filtration rate (GFR) in the first 2 to 3 days post-LT. 10 Historically, the CLKT procedure is performed as a single contiguous procedure in which the KT immediately follows the LT.…”

mentioning

confidence: 99%

A Novel Approach in Combined Liver and Kidney Transplantation With Long-term Outcomes

et al. 2017

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Minimal Improvement in Glomerular Filtration Rate in the First Year After Liver Transplantation

Cited by 12 publications

References 23 publications

Liver alone or simultaneous liver-kidney transplant? Pretransplant chronic kidney disease and post-transplant outcome - a retrospective study

Liver alone or simultaneous liver-kidney transplant? Pretransplant chronic kidney disease and post-transplant outcome - a retrospective study

The use of induction therapy in liver transplantation is highly variable and is associated with posttransplant outcomes

A Novel Approach in Combined Liver and Kidney Transplantation With Long-term Outcomes

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