Emilie Trinh1, Ahsan Alam1, Jean Tchervenkov2, Marcelo Cantarovich1. 1. Division of Nephrology, Multi-Organ Transplant Program, McGill University Health Center, Montreal, QC, Canada. 2. Division of General Surgery, Multi-Organ Transplant Program, McGill University Health Center, Montreal, QC, Canada.
Abstract
BACKGROUND: The incidence of acute kidney injury (AKI) after liver transplantation (LTx) ranges from 17% to 94%. AKI is associated with prolonged hospitalization and increased early mortality. In our cohort study, we examined the impact of AKI on long-term patient survival and on the incidence of stage 4-5 chronic kidney disease (CKD). METHODS: We studied 491 LTx recipients at a single center between 1990 and 2012. We identified 278 pts (56.6%) with AKI defined as either an increase in serum creatinine (SCr) ≥26.5 μmol/L within 48 hour or elevation in SCr 1.5× baseline within 7 days (KDIGO criteria). RESULTS: In a multivariable Cox proportional hazards model, survival was worse in patients with AKI (HR: 1.41, 95% CI 1.03-1.92). Severe (stage 3) AKI was associated with worse patient survival (HR: 2.29, 95% CI 1.46-3.58). The risk of developing stage 4-5 CKD was also higher in patients with AKI (17.5% vs 9.1%) with a HR of 2.39 (95% CI 1.27-4.47). Delaying initiation of calcineurin inhibitors >48H was not associated with a decreased risk of CKD. CONCLUSIONS: Our findings suggest that AKI after LTx is associated with poor long-term outcomes, including worse survival and higher incidence of CKD stage 4-5. Strategies to prevent and manage LTx patients with AKI need to be developed.
BACKGROUND: The incidence of acute kidney injury (AKI) after liver transplantation (LTx) ranges from 17% to 94%. AKI is associated with prolonged hospitalization and increased early mortality. In our cohort study, we examined the impact of AKI on long-term patient survival and on the incidence of stage 4-5 chronic kidney disease (CKD). METHODS: We studied 491 LTx recipients at a single center between 1990 and 2012. We identified 278 pts (56.6%) with AKI defined as either an increase in serum creatinine (SCr) ≥26.5 μmol/L within 48 hour or elevation in SCr 1.5× baseline within 7 days (KDIGO criteria). RESULTS: In a multivariable Cox proportional hazards model, survival was worse in patients with AKI (HR: 1.41, 95% CI 1.03-1.92). Severe (stage 3) AKI was associated with worse patient survival (HR: 2.29, 95% CI 1.46-3.58). The risk of developing stage 4-5 CKD was also higher in patients with AKI (17.5% vs 9.1%) with a HR of 2.39 (95% CI 1.27-4.47). Delaying initiation of calcineurin inhibitors >48H was not associated with a decreased risk of CKD. CONCLUSIONS: Our findings suggest that AKI after LTx is associated with poor long-term outcomes, including worse survival and higher incidence of CKD stage 4-5. Strategies to prevent and manage LTxpatients with AKI need to be developed.
Authors: Zakiyah Kadry; Jonathan G Stine; Takehiko Dohi; Ashokkumar Jain; Kimberly L Robyak; Osun Kwon; Christopher J Hamilton; Piotr Janicki; Thomas R Riley; Fauzia Butt; Karen Krok; Ian R Schreibman; Dmitri Bezinover; Nasrollah Ghahramani; Stalin Campos; Christopher S Hollenbeak Journal: Transplant Direct Date: 2021-06-08