*Purpose: Acute kidney injury(AKI) is a frequent complication after liver transplantation(LT), and is associated with high mortality. Continuous Renal Replacement Therapy (CRRT) is a blood purification technique, which is an important treatment for AKI. The optimal time for initiation of CRRT after onset of AKI to improve clinical outcomes remains uncertain. The purpose of this study is to assess the effects of different timing (early and late) of CRRT initiation on prognosis in patients with AKI after liver transplantation.

*Methods: We retrospectively reviewed clinical data of 173 recipients undergoing liver transplantation from January 2018 to March 2019. AKI was defined according to KDIGO criteria. All patients receiving CRRT were divided into early group(urine output >0.05 mL/kg/h)and late group(urine output <0.05 mL/kg/h)according to urine output during the 24 hours prior to CRRT. The intensive care unit(ICU)and hospital length of stay (LOS), post-operative 90 day mortality, severe infection, and incidence of early allograft dysfunction (EAD) were compared between the two groups.

*Results: A total of 48(27.8%) patients were identified with AKI, 23(13.3%) of whom received CRRT. According to urine output, 13(56.5%) patients were in early group and 10 (43.5%) patients in late group. AKI was associated with longer ICU length of stay (median, 85 [interquartile range (IQR), 21.5-196.5] vs 28.6 [IQR, 15-42] hours, p <0.05) and hospital LOS(median, 24.5 [IQR, 17-40] vs 20 [IQR, 15-29] days, p = 0.003), increased post-operative 90 day mortality (27.1 vs 1.6%, P<0.05) and the incidence of EAD (52.1 vs 21.6%, P<0.05). Patients in late CRRT group had a longer ICU length of stay(median, 183.5 [IQR, 92.25-336.75] vs 139 [IQR, 94-240] hours, p = 0.043)and hospital LOS (median, 38.5 [IQR, 17.5-62.75] vs 35 [IQR, 17-38] days, p = 0.019)than patients in early CRRT group, respectively. The rate of severe infection was significantly higher in the late CRRT group than in the early CRRT group (80.0 vs 30.8%, P= 0.026). There was no significant difference in 90 day mortality rate and incidence of EAD between the early and late CRRT groups.

*Conclusions: Post-LT AKI was associated with longer ICU length of stay and hospital LOS, poorer short-term mortality and functional recovery of transplanted organ. Early initiation of CRRT could reduce the severe infection, ICU length of stay and hospital LOS.

« Back to 2020 American Transplant Congress