The relationship between preoperative creatinine clearance and outcomes for patients undergoing liver transplantation: a retrospective observational study

• Published in: BMC nephrology Vol. 14; no. 1; p. 37
• Main Authors: Wenger, Urs, Neff, Thomas A, Oberkofler, Christian E, Zimmermann, Manuel, Stehberger, Paul A, Scherrer, Marcel, Schuepbach, Reto A, Cottini, Silvia R, Steiger, Peter, Béchir, Markus
• Format: Journal Article
• Language: English
• Published: England BioMed Central 14.02.2013; BioMed Central Ltd; BMC
• Subjects: Acute on chronic renal failure; Acute renal failure; Adolescent; Adult; Aged; Causality; Creatinine - blood; Female; Glomerular Filtration Rate; Humans; Incidence; Kidneys; Liver cirrhosis; Liver transplantation; Liver Transplantation - mortality; Male; Middle Aged; Mortality; Nephrology; Preoperative Care - statistics & numerical data; Renal Insufficiency - blood; Renal Insufficiency - mortality; Renal replacement therapy; Respiratory distress syndrome; Retrospective Studies; Risk Factors; Survival Analysis; Survival Rate; Transplants & implants; Treatment Outcome; Young Adult
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/1471-2369-14-37

Renal failure with following continuous renal replacement therapy is a major clinical problem in liver transplant recipients, with reported incidences of 3% to 20%. Little is known about the significance of postoperative acute renal failure or acute-on-chronic renal failure to postoperative outcome in liver transplant recipients. In this post hoc analysis we compared the mortality rates of 135 consecutive liver transplant recipients over 6 years in our center subject to their renal baseline conditions and postoperative RRT. We classified the patients into 4 groups, according to their preoperative calculated Cockcroft formula and the incidence of postoperative renal replacement therapy. Data then were analyzed in regard to mortality rates and in addition to pre- and peritransplant risk factors. There was a significant difference in ICU mortality (p=.008), hospital mortality (p=.002) and cumulative survival (p<.0001) between the groups. The highest mortality rate occurred in the group with RRT and normal baseline kidney function (20% ICU mortality, 26.6% hospital mortality and 50% cumulative 1-year mortality, respectively). The hazard ratio in this group was 9.6 (CI 3.2-28.6, p=.0001). This study shows that in liver transplant recipient's acute renal failure with postoperative RRT is associated with mortality and the mortality rate is higher than in patients with acute-on-chronic renal failure and postoperative renal replacement therapy.