Predicting renal function after orthotopic liver transplant

Duration of pretransplantation creatinine elevation, but not cause of renal dysfunction predicts renal outcome in orthotopic liver transplantation alone recipients, finds the most recent issue of Liver Transplantation.

In patients with recent onset renal insufficiency, the decision to perform combined kidney/liver transplantation vs orthotopic liver transplantation alone can be difficult.

Dr Rajender Reddy and colleagues hypothesized that duration of renal dysfunction may correlate with creatinine elevation after liver transplantation.

The researchers retrospectively identified 69 liver transplantation patients with pretransplantation creatinine 1.5 mg/dL.

The team included 53 patients with orthotopic liver transplantation alone, and 13 combined kidney/liver transplantation.

Variables analyzed were presence of hepatorenal syndrome, creatinine, Model for End-Stage Liver Disease score, and albumin levels.

The researchers also analyzed age, race, gender, cause of liver disease, diabetes mellitus, hypertension, history of ascites, and spontaneous bacterial peritonitis.

Creatinine levels in the orthotopic liver transplantation alone group were 2 mg/L

Liver Transplantation

In addition, variceal bleeding, hepatic encephalopathy, renal replacement therapy, and transjugular intrahepatic portosystemic shunting were assessed.

The team reported that duration of pretransplantation renal dysfunction was predictive of 6- and 12-month creatinine post- orthotopic liver transplantation alone.

The researchers found that area under the receiver operating characteristic curve for prediction of 12-month renal insufficiency by renal dysfunction duration was 0.7.

The team noted that optimal duration cutoff was 4 weeks.

A multivariable model was derived from patients with orthotopic liver transplantation alone.

The team applied this model to combined kidney/liver transplantation subjects with definite or possible hepatorenal syndrome.

The research team observed that predicted 12-month creatinine without renal transplantation was more than 2 mg/dL for each patient.

Combined kidney/liver transplantation patients as opposed to orthotopic liver transplantation alone patients had longer duration of renal dysfunction of 18 vs 3 weeks.

The team found that patients with combined kidney/liver transplantation had higher creatinine levels of 4 mg/dL vs 2 mg/dL in the orthotopic liver transplantation alone group.

Patients with combined kidney/liver transplantation had a higher rate of pretransplantation renal replacement therapy, of 62% vs 7%.

Combined kidney/liver transplantation patients had lower creatinine than orthotopic liver transplantation alone patients at 6 months and 12 months after transplantation.

Dr Rajender Reddy's team concluded, “Duration, but not cause, of renal dysfunction predicts renal outcome in orthotopic liver transplantation alone recipients.”

“Prospective studies may use duration of renal dysfunction to help identify combined kidney/liver transplantation candidates.”