The changing impact of pre-liver transplant renal dysfunction on post-transplant survival: results of 2 decades from a single center
Introduction and Objectives: Renal dysfunction before liver transplantation (LT) is associated with higher post-LT mortality. We aimed to study if this association still persisted in the contemporary transplant era. Materials and Methods: We retrospectively reviewed data on 2871 primary LT performed...
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doaj-1ae4f5a6860d40cdbb7bb8bbc30776632021-09-11T04:28:00ZengElsevierAnnals of Hepatology1665-26812021-09-0124100317The changing impact of pre-liver transplant renal dysfunction on post-transplant survival: results of 2 decades from a single centerHani M. Wadei0C. Burcin Taner1Andrew P. Keaveny2Martin L. Mai3David O. Hodge4Launia J. White5Denis M. Harnois6Shennen A. Mao7Tambi Jarmi8Kristopher P. Croome9Department of Transplant, Mayo Clinic Florida, United States; Corresponding author at: Department of Transplant, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, United States.Department of Transplant, Mayo Clinic Florida, United StatesDepartment of Transplant, Mayo Clinic Florida, United StatesDepartment of Transplant, Mayo Clinic Florida, United StatesDepartment of Health Sciences Research, Mayo Clinic Florida, United StatesDepartment of Health Sciences Research, Mayo Clinic Florida, United StatesDepartment of Transplant, Mayo Clinic Florida, United StatesDepartment of Transplant, Mayo Clinic Florida, United StatesDepartment of Transplant, Mayo Clinic Florida, United StatesDepartment of Transplant, Mayo Clinic Florida, United StatesIntroduction and Objectives: Renal dysfunction before liver transplantation (LT) is associated with higher post-LT mortality. We aimed to study if this association still persisted in the contemporary transplant era. Materials and Methods: We retrospectively reviewed data on 2871 primary LT performed at our center from 1998 to 2018. All patients were listed for LT alone and were not considered to be simultaneous liver–kidney (SLK) transplant candidates. SLK recipients and those with previous LT were excluded. Patients were grouped into 4 eras: era-1 (1998–2002, n = 488), era-2 (2003–2007, n = 889), era-3 (2008–2012, n = 703) and era-4 (2013–2018, n = 791). Pre-LT renal dysfunction was defined as creatinine (Cr) >1.5 mg/dl or on dialysis at LT. The effect of pre-LT renal dysfunction on post-LT patient survival in each era was examined using Kaplan Meier estimates and univariate and multivariate Cox proportional hazard analyses. Results: Pre-LT renal dysfunction was present in 594 (20%) recipients. Compared to patients in era-1, patients in era-4 had higher Cr, lower eGFR and were more likely to be on dialysis at LT (P < 0.001). Pre-LT renal dysfunction was associated with worse 1, 3 and 5-year survival in era-1 and era-2 (P < 0.005) but not in era-3 or era-4 (P = 0.13 and P = 0.08, respectively). Multivariate analysis demonstrated the lack of independent effect of pre-LT renal dysfunction on post-LT mortality in era-3 and era-4. A separate analysis using eGFR <60 mL/min/1.73 m2 at LT to define renal dysfunction showed similar results. Conclusions: Pre-LT renal dysfunction had less impact on post-LT survival in the contemporary transplant era.http://www.sciencedirect.com/science/article/pii/S1665268121000168Pre-LT renal dysfunctionLiver transplant outcome |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Hani M. Wadei C. Burcin Taner Andrew P. Keaveny Martin L. Mai David O. Hodge Launia J. White Denis M. Harnois Shennen A. Mao Tambi Jarmi Kristopher P. Croome |
spellingShingle |
Hani M. Wadei C. Burcin Taner Andrew P. Keaveny Martin L. Mai David O. Hodge Launia J. White Denis M. Harnois Shennen A. Mao Tambi Jarmi Kristopher P. Croome The changing impact of pre-liver transplant renal dysfunction on post-transplant survival: results of 2 decades from a single center Annals of Hepatology Pre-LT renal dysfunction Liver transplant outcome |
author_facet |
Hani M. Wadei C. Burcin Taner Andrew P. Keaveny Martin L. Mai David O. Hodge Launia J. White Denis M. Harnois Shennen A. Mao Tambi Jarmi Kristopher P. Croome |
author_sort |
Hani M. Wadei |
title |
The changing impact of pre-liver transplant renal dysfunction on post-transplant survival: results of 2 decades from a single center |
title_short |
The changing impact of pre-liver transplant renal dysfunction on post-transplant survival: results of 2 decades from a single center |
title_full |
The changing impact of pre-liver transplant renal dysfunction on post-transplant survival: results of 2 decades from a single center |
title_fullStr |
The changing impact of pre-liver transplant renal dysfunction on post-transplant survival: results of 2 decades from a single center |
title_full_unstemmed |
The changing impact of pre-liver transplant renal dysfunction on post-transplant survival: results of 2 decades from a single center |
title_sort |
changing impact of pre-liver transplant renal dysfunction on post-transplant survival: results of 2 decades from a single center |
publisher |
Elsevier |
series |
Annals of Hepatology |
issn |
1665-2681 |
publishDate |
2021-09-01 |
description |
Introduction and Objectives: Renal dysfunction before liver transplantation (LT) is associated with higher post-LT mortality. We aimed to study if this association still persisted in the contemporary transplant era. Materials and Methods: We retrospectively reviewed data on 2871 primary LT performed at our center from 1998 to 2018. All patients were listed for LT alone and were not considered to be simultaneous liver–kidney (SLK) transplant candidates. SLK recipients and those with previous LT were excluded. Patients were grouped into 4 eras: era-1 (1998–2002, n = 488), era-2 (2003–2007, n = 889), era-3 (2008–2012, n = 703) and era-4 (2013–2018, n = 791). Pre-LT renal dysfunction was defined as creatinine (Cr) >1.5 mg/dl or on dialysis at LT. The effect of pre-LT renal dysfunction on post-LT patient survival in each era was examined using Kaplan Meier estimates and univariate and multivariate Cox proportional hazard analyses. Results: Pre-LT renal dysfunction was present in 594 (20%) recipients. Compared to patients in era-1, patients in era-4 had higher Cr, lower eGFR and were more likely to be on dialysis at LT (P < 0.001). Pre-LT renal dysfunction was associated with worse 1, 3 and 5-year survival in era-1 and era-2 (P < 0.005) but not in era-3 or era-4 (P = 0.13 and P = 0.08, respectively). Multivariate analysis demonstrated the lack of independent effect of pre-LT renal dysfunction on post-LT mortality in era-3 and era-4. A separate analysis using eGFR <60 mL/min/1.73 m2 at LT to define renal dysfunction showed similar results. Conclusions: Pre-LT renal dysfunction had less impact on post-LT survival in the contemporary transplant era. |
topic |
Pre-LT renal dysfunction Liver transplant outcome |
url |
http://www.sciencedirect.com/science/article/pii/S1665268121000168 |
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