The changing impact of pre-liver transplant renal dysfunction on post-transplant survival: results of 2 decades from a single center.
Ann Hepatol
; 24: 100317, 2021.
Article
em En
| MEDLINE
| ID: mdl-33545403
ABSTRACT
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 ANDMETHODS:
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, nâ¯=â¯488), era-2 (2003-2007, nâ¯=â¯889), era-3 (2008-2012, nâ¯=â¯703) and era-4 (2013-2018, nâ¯=â¯791). Pre-LT renal dysfunction was defined as creatinine (Cr) >1.5â¯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 (Pâ¯<â¯0.001). Pre-LT renal dysfunction was associated with worse 1, 3 and 5-year survival in era-1 and era-2 (Pâ¯<â¯0.005) but not in era-3 or era-4 (Pâ¯=â¯0.13 and Pâ¯=â¯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 <60â¯mL/min/1.73â¯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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Transplante de Fígado
/
Insuficiência Renal
/
Hepatopatias
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
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Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Ann Hepatol
Assunto da revista:
GASTROENTEROLOGIA
Ano de publicação:
2021
Tipo de documento:
Article