Renal Failure is Reversible in the Majority of Patients Transplanted for Alcohol-Associated Hepatitis: A Review of the UNOS Database
Icahn School of Medicine at Mount Sinai, RMTI, New York, NY
Meeting: 2022 American Transplant Congress
Abstract number: 128
Keywords: Alcohol, Kidney, Liver transplantation, Renal failure
Topic: Clinical Science » Liver » 52 - Liver: Kidney Issues in Liver Transplantation
Session Information
Session Name: Cirrhosis: Complications, Portal Hypertension and Renal Management
Session Type: Rapid Fire Oral Abstract
Date: Sunday, June 5, 2022
Session Time: 5:30pm-7:00pm
Presentation Time: 6:30pm-6:40pm
Location: Hynes Room 311
*Purpose: The simultaneous liver-kidney (SLK) allocation policy in 2017 created Safety Net kidney allocation priority for liver transplant (LT) recipients with renal failure. Renal failure is a common complication in patients with alcohol-associated hepatitis (AH), but the predictors of kidney recovery after LT and the impact of the SLK allocation policy have not been elucidated.
*Methods: Using UNOS data from 2012 to 2021, adult patients who underwent primary LT for AH were analyzed. Patients were categorized into 4 groups based on pre-LT renal replacement therapy (RRT) status, and transplant procedure (LT or SLK): RRT- LT, RRT-SLK, non-RRT-LT, and non-RRT-SLK. RRT-LT group was further evaluated for kidney recovery. (Figure 1)
*Results: RRT was indicated in nearly half (47.7%) of 821 LT recipients for AH: 356 patients (43.4%) in RRT-LT group and 36 (9.2%) in RRT-SLK group. After implementation of the new SLK allocation policy, the rate of SLK among recipients with RRT significantly decreased from 22.7% to 6.4% (p<0.01). As expected, patients with RRT had a significantly higher MELD score, and shorter waiting time than those without RRT (all p<0.01). Patient survival amongst the groups showed no significant difference (p=0.25). Among 353 patients in the RRT-LT group, 53 patients (15.0%) were listed for kidney transplant (KT) within 1 year after LT. After the implementation of SLK allocation policy, the rate to list for KT increased to 16.6% from 5.9%, but the difference did not reach statistical significance (p=0.07). Patients who were listed for KT showed a significantly higher bilirubin, creatinine (both p<0.01) and lower albumin (p=0.02) at listing for LT (Table 1). Multivariable regression analysis identified bilirubin [ (HR) 1.05, 95% CI 1.02-1.08], and albumin (HR 1.01, 95% CI 0.39-0.88) at listing for LT as predictors for KT listing after LT.
*Conclusions: Almost half of the patients with AH required RRT before LT, but renal failure resolved in the great majority (85.0%) of patients post-LT. The new SLK allocation policy effectively reduced SLK rates, but with higher rates of KT post-LT using the “safety net”. Serum bilirubin and albumin at the time of LT listing may help identify patients who will require KT after LT.
| Variables | Non-kidney listing (n=275) | Kidney listed (n=53) | Mortality (n=25) | P value |
| Age (years) | 41.2 ± 9.3 | 42.2 ± 10.5 | 40.1 ± 7.9 | 0.65 |
| MELD score at listing | 39.4 ± 5.1 | 40.8 ± 2.8 | 39.8 ± 3.7 | 0.10 |
| Bili at listing | 26.9 ± 11.5 | 33.1 ± 9.5 | 28.4 ± 13.7 | < 0.01 |
| INR at listing | 2.4 ± 0.9 | 2.2 ± 0.6 | 2.3 ± 0.6 | 0.41 |
| Creatinine at listing | 3.5 ± 2.2 | 4.4 ± 2.4 | 2.9 ± 1.7 | < 0.01 |
| Alb at listing | 3.1 ± 0.7 | 2.8 ± 0.6 | 3.0 ± 0.6 | 0.02 |
To cite this abstract in AMA style:
Bekki Y, Im G, Schiano T, Florman S. Renal Failure is Reversible in the Majority of Patients Transplanted for Alcohol-Associated Hepatitis: A Review of the UNOS Database [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/renal-failure-is-reversible-in-the-majority-of-patients-transplanted-for-alcohol-associated-hepatitis-a-review-of-the-unos-database/. Accessed November 23, 2024.« Back to 2022 American Transplant Congress