Renal function after orthotopic liver transplantation is predicted by duration of pretransplantation creatinine elevation

Mical S. Campbell, David S. Kotlyar, Colleen M. Brensinger, James D. Lewis, Kirti Shetty, Roy D. Bloom, James F. Markmann, Kim M. Olthoff, Abraham Shaked, K. Rajender Reddy

Research output: Contribution to journalArticle

Abstract

In patients with recent onset renal insufficiency, the decision to performe combined kidney/liver transplantation (CKLT) vs. orthotopic liver transplantation alone (OLTa) can be difficult. We hypothesized that duration of renal dysfunction may correlate with creatinine elevation after liver transplantation. We retrospectively identified 69 liver transplantation patients with pretransplantation creatinine ≥1.5 mg/dL (53 OLTa, 13 CKLT). Variables analyzed were presence of hepatorenal syndrome, creatinine, Model for End-Stage Liver Disease score, albumin, age, race, gender, cause of liver disease, diabetes mellitus, hypertension, and history of ascites, spontaneous bacterial peritonitis, variceal bleeding, hepatic encephalopathy, renal replacement therapy (RRT), and transjugular intrahepatic portosystemic shunting. Duration of pretransplantation renal dysfunction was predictive of 6- and 12-month creatinine post-OLTa. Area under the receiver operating characteristic (ROC) curve for prediction of 12-month renal insufficiency by renal dysfunction duration was 0.71; optimal duration cutoff was 3.6 weeks. We applied a multivariable model, derived from OLTa patients, to CKLT subjects with definite or possible hepatorenal syndrome. Predicted 12-month creatinine without renal transplantation was >2.0 mg/dL for each patient. CKLT patients as opposed to OLTa patients had longer duration of renal dysfunction (median, 18.1 vs. 2.7 weeks, P <0.001), higher creatinine (median 4.0 versus 1.7 mg/dL, P <0.001), and higher rate of pretransplantation RRT (62% vs. 7%, P <0.001). Adjusting for baseline characteristics, CKLT patients had lower creatinine than OLTa patients at 6 months (P =0.15) and 12 months (P =0.01) after transplantation. In conclusion, duration, but not cause, of renal dysfunction predicts renal outcome in OLTa recipients. Prospective studies may use duration of renal dysfunction to help identify CKLT candidates.

Original languageEnglish (US)
Pages (from-to)1048-1055
Number of pages8
JournalLiver Transplantation
Volume11
Issue number9
DOIs
StatePublished - Sep 2005
Externally publishedYes

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Liver Transplantation
Creatinine
Kidney
Kidney Transplantation
Hepatorenal Syndrome
Renal Replacement Therapy
Renal Insufficiency
End Stage Liver Disease
Hepatic Encephalopathy
Peritonitis
Ascites
ROC Curve
Liver Diseases
Albumins
Diabetes Mellitus
Transplantation
Prospective Studies

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

Campbell, M. S., Kotlyar, D. S., Brensinger, C. M., Lewis, J. D., Shetty, K., Bloom, R. D., ... Reddy, K. R. (2005). Renal function after orthotopic liver transplantation is predicted by duration of pretransplantation creatinine elevation. Liver Transplantation, 11(9), 1048-1055. https://doi.org/10.1002/lt.20445

Renal function after orthotopic liver transplantation is predicted by duration of pretransplantation creatinine elevation. / Campbell, Mical S.; Kotlyar, David S.; Brensinger, Colleen M.; Lewis, James D.; Shetty, Kirti; Bloom, Roy D.; Markmann, James F.; Olthoff, Kim M.; Shaked, Abraham; Reddy, K. Rajender.

In: Liver Transplantation, Vol. 11, No. 9, 09.2005, p. 1048-1055.

Research output: Contribution to journalArticle

Campbell, MS, Kotlyar, DS, Brensinger, CM, Lewis, JD, Shetty, K, Bloom, RD, Markmann, JF, Olthoff, KM, Shaked, A & Reddy, KR 2005, 'Renal function after orthotopic liver transplantation is predicted by duration of pretransplantation creatinine elevation', Liver Transplantation, vol. 11, no. 9, pp. 1048-1055. https://doi.org/10.1002/lt.20445
Campbell, Mical S. ; Kotlyar, David S. ; Brensinger, Colleen M. ; Lewis, James D. ; Shetty, Kirti ; Bloom, Roy D. ; Markmann, James F. ; Olthoff, Kim M. ; Shaked, Abraham ; Reddy, K. Rajender. / Renal function after orthotopic liver transplantation is predicted by duration of pretransplantation creatinine elevation. In: Liver Transplantation. 2005 ; Vol. 11, No. 9. pp. 1048-1055.
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abstract = "In patients with recent onset renal insufficiency, the decision to performe combined kidney/liver transplantation (CKLT) vs. orthotopic liver transplantation alone (OLTa) can be difficult. We hypothesized that duration of renal dysfunction may correlate with creatinine elevation after liver transplantation. We retrospectively identified 69 liver transplantation patients with pretransplantation creatinine ≥1.5 mg/dL (53 OLTa, 13 CKLT). Variables analyzed were presence of hepatorenal syndrome, creatinine, Model for End-Stage Liver Disease score, albumin, age, race, gender, cause of liver disease, diabetes mellitus, hypertension, and history of ascites, spontaneous bacterial peritonitis, variceal bleeding, hepatic encephalopathy, renal replacement therapy (RRT), and transjugular intrahepatic portosystemic shunting. Duration of pretransplantation renal dysfunction was predictive of 6- and 12-month creatinine post-OLTa. Area under the receiver operating characteristic (ROC) curve for prediction of 12-month renal insufficiency by renal dysfunction duration was 0.71; optimal duration cutoff was 3.6 weeks. We applied a multivariable model, derived from OLTa patients, to CKLT subjects with definite or possible hepatorenal syndrome. Predicted 12-month creatinine without renal transplantation was >2.0 mg/dL for each patient. CKLT patients as opposed to OLTa patients had longer duration of renal dysfunction (median, 18.1 vs. 2.7 weeks, P <0.001), higher creatinine (median 4.0 versus 1.7 mg/dL, P <0.001), and higher rate of pretransplantation RRT (62{\%} vs. 7{\%}, P <0.001). Adjusting for baseline characteristics, CKLT patients had lower creatinine than OLTa patients at 6 months (P =0.15) and 12 months (P =0.01) after transplantation. In conclusion, duration, but not cause, of renal dysfunction predicts renal outcome in OLTa recipients. Prospective studies may use duration of renal dysfunction to help identify CKLT candidates.",
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AU - Lewis, James D.

AU - Shetty, Kirti

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AU - Markmann, James F.

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