Patterns of kidney function before and after orthotopic liver transplant: Associations with length of hospital stay, progression to end-stage renal disease, and mortality

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Abstract

Background. In the context of orthotopic liver transplantation (OLT), renal dysfunction is used as a criterion for simultaneous liver-kidney transplantation. Changes in glomerular filtration rate (GFR) the year before and after OLT have not been well defined. Methods. In a cohort of 416 OLT patients from 1996 to 2009, estimated GFR (EGFR) was assessed during the 12 months before OLT (period A), at time of OLT (period B), and the 12 months after OLT (period C). Outcomes included progression to end stage renal disease (ESRD), length of stay, and mortality. Results. The overall rate of progression to ESRD over 15 years of follow-up was 0.155/person-year and was strongly associated with EGFR 2) to period B (77; P <0.001) to period C (71; P <0.001), with similar decreases in EGFR across subgroups of clinical variables. Patients with EGFR less than 60mL/min per 1.73 m2 at OLT had acute and large decreases in EGFR from periods A to B, then increases to period C. Length of stay was associated with EGFR at OLT, hepatorenal syndrome, dialysis requirement, model for end-stage liver disease score, and alcoholic liver disease. Twelve-month mortality was strongly associated with timedependent change in EGFR, hepatorenal syndrome, dialysis requirement, hepatitis C, and model for end-stage liver disease era transplantation but was not associated with EGFR at OLT. Conclusions. Among OLT patients, renal function worsened in all subgroups from before to after OLT, but the association of progression to ESRD was particularly high among patients with both diabetes and EGFR less than 60 at the time of OLT. This suggests that diabetes could be considered as a criterion when making decisions regarding simultaneous liver-kidney transplantation.

Original languageEnglish (US)
Pages (from-to)2556-2564
Number of pages9
JournalTransplantation
Volume99
Issue number12
DOIs
StatePublished - 2015

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Liver Transplantation
Chronic Kidney Failure
Length of Stay
Transplants
Kidney
Mortality
Liver
Hepatorenal Syndrome
End Stage Liver Disease
Glomerular Filtration Rate
Kidney Transplantation
Dialysis
Alcoholic Liver Diseases
Hepatitis C
Decision Making
Transplantation

ASJC Scopus subject areas

  • Transplantation

Cite this

@article{7d3678ba10ec41fa8db95934e2122ba4,
title = "Patterns of kidney function before and after orthotopic liver transplant: Associations with length of hospital stay, progression to end-stage renal disease, and mortality",
abstract = "Background. In the context of orthotopic liver transplantation (OLT), renal dysfunction is used as a criterion for simultaneous liver-kidney transplantation. Changes in glomerular filtration rate (GFR) the year before and after OLT have not been well defined. Methods. In a cohort of 416 OLT patients from 1996 to 2009, estimated GFR (EGFR) was assessed during the 12 months before OLT (period A), at time of OLT (period B), and the 12 months after OLT (period C). Outcomes included progression to end stage renal disease (ESRD), length of stay, and mortality. Results. The overall rate of progression to ESRD over 15 years of follow-up was 0.155/person-year and was strongly associated with EGFR 2) to period B (77; P <0.001) to period C (71; P <0.001), with similar decreases in EGFR across subgroups of clinical variables. Patients with EGFR less than 60mL/min per 1.73 m2 at OLT had acute and large decreases in EGFR from periods A to B, then increases to period C. Length of stay was associated with EGFR at OLT, hepatorenal syndrome, dialysis requirement, model for end-stage liver disease score, and alcoholic liver disease. Twelve-month mortality was strongly associated with timedependent change in EGFR, hepatorenal syndrome, dialysis requirement, hepatitis C, and model for end-stage liver disease era transplantation but was not associated with EGFR at OLT. Conclusions. Among OLT patients, renal function worsened in all subgroups from before to after OLT, but the association of progression to ESRD was particularly high among patients with both diabetes and EGFR less than 60 at the time of OLT. This suggests that diabetes could be considered as a criterion when making decisions regarding simultaneous liver-kidney transplantation.",
author = "Longenecker, {J. Craig} and Estrella, {Michelle M.} and Dorry Segev and Mohamed Atta",
year = "2015",
doi = "10.1097/TP.0000000000000767",
language = "English (US)",
volume = "99",
pages = "2556--2564",
journal = "Transplantation",
issn = "0041-1337",
publisher = "Lippincott Williams and Wilkins",
number = "12",

}

TY - JOUR

T1 - Patterns of kidney function before and after orthotopic liver transplant

T2 - Associations with length of hospital stay, progression to end-stage renal disease, and mortality

AU - Longenecker, J. Craig

AU - Estrella, Michelle M.

AU - Segev, Dorry

AU - Atta, Mohamed

PY - 2015

Y1 - 2015

N2 - Background. In the context of orthotopic liver transplantation (OLT), renal dysfunction is used as a criterion for simultaneous liver-kidney transplantation. Changes in glomerular filtration rate (GFR) the year before and after OLT have not been well defined. Methods. In a cohort of 416 OLT patients from 1996 to 2009, estimated GFR (EGFR) was assessed during the 12 months before OLT (period A), at time of OLT (period B), and the 12 months after OLT (period C). Outcomes included progression to end stage renal disease (ESRD), length of stay, and mortality. Results. The overall rate of progression to ESRD over 15 years of follow-up was 0.155/person-year and was strongly associated with EGFR 2) to period B (77; P <0.001) to period C (71; P <0.001), with similar decreases in EGFR across subgroups of clinical variables. Patients with EGFR less than 60mL/min per 1.73 m2 at OLT had acute and large decreases in EGFR from periods A to B, then increases to period C. Length of stay was associated with EGFR at OLT, hepatorenal syndrome, dialysis requirement, model for end-stage liver disease score, and alcoholic liver disease. Twelve-month mortality was strongly associated with timedependent change in EGFR, hepatorenal syndrome, dialysis requirement, hepatitis C, and model for end-stage liver disease era transplantation but was not associated with EGFR at OLT. Conclusions. Among OLT patients, renal function worsened in all subgroups from before to after OLT, but the association of progression to ESRD was particularly high among patients with both diabetes and EGFR less than 60 at the time of OLT. This suggests that diabetes could be considered as a criterion when making decisions regarding simultaneous liver-kidney transplantation.

AB - Background. In the context of orthotopic liver transplantation (OLT), renal dysfunction is used as a criterion for simultaneous liver-kidney transplantation. Changes in glomerular filtration rate (GFR) the year before and after OLT have not been well defined. Methods. In a cohort of 416 OLT patients from 1996 to 2009, estimated GFR (EGFR) was assessed during the 12 months before OLT (period A), at time of OLT (period B), and the 12 months after OLT (period C). Outcomes included progression to end stage renal disease (ESRD), length of stay, and mortality. Results. The overall rate of progression to ESRD over 15 years of follow-up was 0.155/person-year and was strongly associated with EGFR 2) to period B (77; P <0.001) to period C (71; P <0.001), with similar decreases in EGFR across subgroups of clinical variables. Patients with EGFR less than 60mL/min per 1.73 m2 at OLT had acute and large decreases in EGFR from periods A to B, then increases to period C. Length of stay was associated with EGFR at OLT, hepatorenal syndrome, dialysis requirement, model for end-stage liver disease score, and alcoholic liver disease. Twelve-month mortality was strongly associated with timedependent change in EGFR, hepatorenal syndrome, dialysis requirement, hepatitis C, and model for end-stage liver disease era transplantation but was not associated with EGFR at OLT. Conclusions. Among OLT patients, renal function worsened in all subgroups from before to after OLT, but the association of progression to ESRD was particularly high among patients with both diabetes and EGFR less than 60 at the time of OLT. This suggests that diabetes could be considered as a criterion when making decisions regarding simultaneous liver-kidney transplantation.

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DO - 10.1097/TP.0000000000000767

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JF - Transplantation

SN - 0041-1337

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