Early Allograft Dysfunction After Liver Transplantation Is Associated With Short‐ and Long‐Term Kidney Function Impairment

• Published in: American journal of transplantation Vol. 16; no. 3; pp. 850 - 859
• Main Authors: Wadei, H. M., Lee, D. D., Croome, K. P., Mai, M. L., Golan, E., Brotman, R., Keaveny, A. P., Taner, C. B.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.03.2016
• Subjects: Acute Kidney Injury - etiology; Acute Kidney Injury - pathology; Allografts; clinical research/practice; complication: medical/metabolic; delayed graft function (DGF); Female; Follow-Up Studies; Glomerular Filtration Rate; Graft Rejection - etiology; Graft Rejection - pathology; Graft Survival; Health risk assessment; Humans; Inflammation; Ischemia; kidney disease; Kidney Failure, Chronic - etiology; Kidney Failure, Chronic - pathology; Kidney Function Tests; Kidney transplantation; kidney transplantation/nephrology; Kidney transplants; liver allograft function/dysfunction; Liver diseases; Liver Diseases - surgery; Liver transplantation; Liver Transplantation - adverse effects; liver transplantation/hepatology; Liver transplants; Male; Middle Aged; Postoperative Complications; Primary Graft Dysfunction - etiology; Primary Graft Dysfunction - pathology; Prognosis; Renal function; Reperfusion; Risk Factors; Survival Rate; Tissue Donors; liver allograft function/dysfunction; clinical research/practice; kidney transplantation/nephrology; graft survival; kidney disease; complication: medical/metabolic; delayed graft function (DGF); liver transplantation/hepatology
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/ajt.13527

Early allograft dysfunction (EAD) after liver transplantation (LT) is related to ischemia–reperfusion injury and may lead to a systemic inflammatory response and extrahepatic organ dysfunction. We evaluated the effect of EAD on new‐onset acute kidney injury (AKI) requiring renal replacement therapy within the first month and end‐stage renal disease (ESRD) within the first year post‐LT in 1325 primary LT recipients. EAD developed in 358 (27%) of recipients. Seventy‐one (5.6%) recipients developed AKI and 38 (2.9%) developed ESRD. Compared with those without EAD, recipients with EAD had a higher risk of AKI and ESRD (4% vs. 9% and 2% vs. 6%, respectively, p < 0.001 for both). Multivariate logistic regression analysis showed an independent relationship between EAD and AKI as well as ESRD (odds ratio 3.5, 95% confidence interval 1.9–6.4, and odds ratio 3.1, 95% confidence interval 11.9–91.2, respectively). Patients who experienced both EAD and AKI had inferior 1‐, 3‐, 5‐, and 10‐year patient and graft survival compared with those with either EAD or AKI alone, while those who had neither AKI nor EAD had the best outcomes (p < 0.001). Post‐LT EAD is a risk factor for both AKI and ESRD and should be considered a target for future intervention to reduce post‐LT short‐ and long‐term renal dysfunction. In this study of 1325 primary liver transplant recipients, the authors identify a link between early liver allograft dysfunction and new onset acute kidney injury within one month and end‐stage renal disease at one year after liver transplantation.