Prognostic factors of early acute renal failure in liver transplantation

Cabezuelo, J B; Ramı́rez, Pablo; Acosta, F; Bueno, F.S; Robles, R; Pons, JA; Miras, M.; Munítiz, Vicente; Fernández, José Antonio de Paz; Lujan, J; Rodrı́guez, José Manuel; Bru, Mariano; Berenguer, Jordi; P, Parrilla Paricio

doi:10.1016/s0041-1345(01)02749-x

Cited by 36 publications

(35 citation statements)

References 4 publications

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“…Apart from higher postoperative costs, renal failure and subsequent need for RRT is associated with increased mortality in ICU patients in general [29] and in particular in liver transplant recipients, varying from 27% to 67% depending on the comorbidities [30-33]. There is strong evidence that even mild renal failure after transplantation might lead to longer hospital stay, more infections and increased overall mortality [33-35].…”

Section: Discussionmentioning

confidence: 99%

Model of end stage liver disease (MELD) score greater than 23 predicts length of stay in the ICU but not mortality in liver transplant recipients

et al. 2010

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IntroductionThe impact of model of end stage liver disease (MELD) score on postoperative morbidity and mortality is still elusive, especially for high MELD. There are reports of poorer patient outcome in transplant candidates with high MELD score, others though report no influence of MELD score on outcome and survival.MethodsWe retrospectively analyzed data of 144 consecutive liver transplant recipients over a 72-month period in our transplant unit, from January 2003 until December 2008 and performed uni- and multivariate analysis for morbidity and mortality, in particular to define the influence of MELD to these parameters.ResultsThis study identified MELD score greater than 23 as an independent risk factor of morbidity represented by intensive care unit (ICU) stay longer than 10 days (odds ratio 7.0) but in contrast had no negative impact on mortality. Furthermore, we identified transfusion of more than 7 units of red blood cells as independent risk factor for mortality (hazard ratio 7.6) and for prolonged ICU stay (odds ratio [OR] 7.8) together with transfusion of more than 10 units of fresh frozen plasma (OR 11.6). Postoperative renal failure is a strong predictor of morbidity (OR 7.9) and postoperative renal replacement therapy was highly associated with increased mortality (hazard ratio 6.8), as was hepato renal syndrome prior to transplantation (hazard ratio 13.2).ConclusionsThis study identified MELD score greater than 23 as an independent risk factor of morbidity represented by ICU stay longer than 10 days but in contrast had no negative impact on mortality. This finding supports the transplantation of patients with high MELD score but only with knowledge of increased morbidity.

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Section: Discussionmentioning

confidence: 99%

Model of end stage liver disease (MELD) score greater than 23 predicts length of stay in the ICU but not mortality in liver transplant recipients

et al. 2010

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“…[2][3][4][5][7][8][9] Delaying the initiation of CNI with anti-thymocyte globulin in patients at high risk of acute renal failure was associated with a recovery in renal function in the early posttransplant period. Patients on this regimen also experienced a continual improvement in renal function, with a greater independence from dialysis, higher estimated GFR, and lower serum creatinine levels than control patients at 12 months posttransplant.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] Early renal dysfunction is a risk factor for chronic renal failure and is associated with significant morbidity and mortality in liver transplant recipients. 2,[4][5][6][7] Many risk factors such as preexisting renal impairment, hepatorenal syndrome, diabetes mellitus, liver allograft dysfunction, significant intraoperative blood loss, infection, and exposure to nephrotoxic calcineurin inhibitors (CNIs) have been reported to be associated with early renal dysfunction and acute renal failure after liver transplantation.…”

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confidence: 99%

Preserving renal function in liver transplant recipients with rabbit anti-thymocyte globulin and delayed initiation of calcineurin inhibitors

et al. 2007

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Early renal dysfunction following liver transplantation is associated with increased morbidity and mortality. To evaluate the impact of delayed initiation of calcineurin inhibitor on renal function, we conducted a retrospective study comparing 118 liver transplant recipients who received rabbit anti-thymocyte globulin and delayed initiation of calcineurin inhibitor with 80 liver transplant recipients who received no antibody and early initiation of calcineurin inhibitor (control group). All patients received mycophenolate mofetil and steroids. Delayed calcineurin inhibitor initiation with anti-thymocyte globulin was associated with significant improvement in renal function throughout the first year post-transplant. At 12 months post-transplant, patients treated with this regimen experienced lower serum creatinine (1.4 Ϯ 0.5 versus 1.7 Ϯ 0.5 mg/dL, P Ͻ 0.001), a higher estimated glomerular filtration rate (57.4 Ϯ 20.5 versus 43.7 Ϯ 14.4 mL/min/1.73 m 2 , P Ͻ 0.001), and less dependence on dialysis (0.8% versus 13%, P Ͻ 0.001) in comparison with no antibody and early calcineurin inhibitor initiation. Patient survival and graft survival were similar between groups; however, there was a trend of a lower incidence of early biopsy-proven acute rejection with anti-thymocyte globulin. Overall infection and cytomegalovirus infection were significantly lower in anti-thymocyte globulin-treated patients, and there was no increased incidence of hepatitis C recurrence in comparison with controls. In conclusion, delayed initiation of calcineurin inhibitor with anti-thymocyte globulin in liver transplant recipients is safe and is associated with improvements in renal function and a lower incidence of early acute rejection in comparison with no antibody and early initiation of calcineurin inhibitor. Liver Transpl 14: 66-72, 2008.

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“…Apart from higher costs renal failure is associated with increased mortality in ICU patients in general [4] and in particular in liver transplant recipients, varying from 27% to 67% depending on the comorbidities [5-7]. …”

Section: Introductionmentioning

confidence: 99%

The relationship between preoperative creatinine clearance and outcomes for patients undergoing liver transplantation: a retrospective observational study

et al. 2013

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BackgroundRenal failure with following continuous renal replacement therapy is a major clinical problem in liver transplant recipients, with reported incidences of 3% to 20%. Little is known about the significance of postoperative acute renal failure or acute-on-chronic renal failure to postoperative outcome in liver transplant recipients.MethodsIn this post hoc analysis we compared the mortality rates of 135 consecutive liver transplant recipients over 6 years in our center subject to their renal baseline conditions and postoperative RRT. We classified the patients into 4 groups, according to their preoperative calculated Cockcroft formula and the incidence of postoperative renal replacement therapy. Data then were analyzed in regard to mortality rates and in addition to pre- and peritransplant risk factors.ResultsThere was a significant difference in ICU mortality (p=.008), hospital mortality (p=.002) and cumulative survival (p<.0001) between the groups. The highest mortality rate occurred in the group with RRT and normal baseline kidney function (20% ICU mortality, 26.6% hospital mortality and 50% cumulative 1-year mortality, respectively). The hazard ratio in this group was 9.6 (CI 3.2-28.6, p=.0001).ConclusionThis study shows that in liver transplant recipient’s acute renal failure with postoperative RRT is associated with mortality and the mortality rate is higher than in patients with acute-on-chronic renal failure and postoperative renal replacement therapy.

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Prognostic factors of early acute renal failure in liver transplantation

Cited by 36 publications

References 4 publications

Model of end stage liver disease (MELD) score greater than 23 predicts length of stay in the ICU but not mortality in liver transplant recipients

Model of end stage liver disease (MELD) score greater than 23 predicts length of stay in the ICU but not mortality in liver transplant recipients

Preserving renal function in liver transplant recipients with rabbit anti-thymocyte globulin and delayed initiation of calcineurin inhibitors

The relationship between preoperative creatinine clearance and outcomes for patients undergoing liver transplantation: a retrospective observational study

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